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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601134
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:29:32 PM

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
07/22/2021 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210722123122
FACILITY NAME:SUNRISE AT LA COSTAFACILITY NUMBER:
374601134
ADMINISTRATOR:LAVENDER, WESLEY DFACILITY TYPE:
740
ADDRESS:7020 MANZANITA STTELEPHONE:
(760) 930-0060
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:120CENSUS: 79DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Executive Director Erica CastilleTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
-Admission agreement was not signed by resident who is the responsible party.
-Resident was not provided with a copy of the admission agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit to deliver findings for the above-mentioned allegations. LPA Silveira identified themselves, stated the purpose of the visit and met with Erica Castille and shared the findings.

The Department’s investigation consisted of interviews and records review. On 07/22/2021 it was alleged that the admission agreement was not signed by resident (R1), who was their own responsible party. It was also alleged that R1 was not provided with a copy of the signed admission agreement.

Records review demonstrated that an admission agreement was signed by R1 on 12/24/19. Interviews with multiple facility staff revealed that it was standard facility procedure to make a copy of the admission agreement and provide it to residents once the agreement had been signed. Interviews with R1 and outside sources revealed that there was uncertainty regarding whether an admission agreement was provided to the resident at the time of admission.

Based on the evidence obtained during the complaint investigation, the above allegations are determined to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report and Licensee's Rights (9058 01/16) were printed and provided to Erica Castille at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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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