370804662-8-30-2023-08-AS-SJAB-CV8RCX-20230831125504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804662
Report Date: 08/30/2023
Date Signed: 08/30/2023 11:08:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2021 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20210827114550

FACILITY NAME:	SUNSHINE CARE HOME		FACILITY NUMBER:	370804662
ADMINISTRATOR:	FRANCIS GRACE REYES		FACILITY TYPE:	740
ADDRESS:	11812 LAKESIDE AVENUE		TELEPHONE:	(619) 561-0161
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY:	21	CENSUS: 16	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Grace Reyes, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Lack of supervision resulting in client altercation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA was met by Administrator, Grace Reyes, introduced herself, and was allowed entry into the facility. LPA met with Ms. Reyes and discussed the purpose of the visit.

Investigation consisted of interviews with clients, staff, and outside sources, record review, and a tour of the facility. It was alleged that lack of supervision resulted in a client altercation. Interviews with staff, clients, and outside sources revealed that on or about 8/25/21, Client #1 (C1) and Client #2 (C2) engaged in an altercation which resulted in physical aggression, but no injuries. Interview with C1 and outside sources revealed that C1 and C2 engaged in an altercation after a disagreement regarding cigarettes. This was the first physical altercation between C1 and C2. Interviews with clients and staff revealed staff were in the area when the incident occurred and intervened. C1 and C2 were admonished by facility staff. Review of records

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210827114550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNSHINE CARE HOME	FACILITY NUMBER: 370804662
	VISIT DATE: 08/30/2023

NARRATIVE

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revealed that both clients are diagnosed with mental health conditions but did not note a history of physical aggression.

The Department has investigated the allegation that lack of supervision resulted in a client altercation. Based on evidence obtained through interviews and record review, there is insufficient evidence to corroborate the allegation. Therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Ms. Reyes. Copies of this report and Licensee/Appeal Rights were provided to her at the conclusion of the visit. Her signature on this report acknowledges receipt of copies of the report and rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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