374601134-10-2-2024-08-AS-SJAB-D9VQAM-20241009120009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601134
Report Date: 09/27/2024
Date Signed: 10/02/2024 11:36:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
08/27/2024 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20240827140738

FACILITY NAME:	SUNRISE AT LA COSTA		FACILITY NUMBER:	374601134
ADMINISTRATOR:	HERNANDEZ, MARLEN		FACILITY TYPE:	740
ADDRESS:	7020 MANZANITA ST		TELEPHONE:	(760) 930-0060
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	120	CENSUS: 92	DATE:	09/27/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Executive Director Marlen Arguero Hernandez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Licensee did not issue resident’s authorized representative a timely refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to deliver investigation findings. LPA was granted entry into the facility and met with Executive Director Arguero Hernandez, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation, records review and interviews with facility staff and outside sources.

On 8/27/2024 it was alleged that the Licensee did not provide Resident 1’s (R1’s) Responsible Party (RP) a full refund after the death of a resident. A records review revealed R1’s RP was issued a full refund of the original pre-paid rent within 15 days the removal of all personal belongs belonging of R1. The full refund was issued on 5/7/2024. The records also indicate an automatic ACH withdrawal was also made on 5/6/2024 from R1’s personal account. Further records reviewed as well as interview with S1 indicates there was an accounting oversight from the licensee and an additional refund was issued 8/23/2024 to R1’s RP. (continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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-20240827140738

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNRISE AT LA COSTA	FACILITY NUMBER: 374601134
	VISIT DATE: 09/27/2024

NARRATIVE

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(Continued from 9099)

Interviews conducted with Responsible Party and the ED Arguero Hernandez, as well as a facility records review revealed the facility issued the RP a refund in an amount meeting the Department’s mandate.

Based on the Department's investigation there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director Arguero Hernandez to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of today's visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC9099 (FAS) - (06/04)

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