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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603394
Report Date: 04/29/2024
Date Signed: 04/29/2024 02:29:55 PM

Substantiated


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
05/03/2023 and conducted by Evaluator Ramon Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230503155824
FACILITY NAME:SUNRISE ASSISTED LIVING AT BONITAFACILITY NUMBER:
374603394
ADMINISTRATOR:GOODING, ROXANNEFACILITY TYPE:
740
ADDRESS:3302 BONITA RDTELEPHONE:
(619) 470-2220
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:96CENSUS: 67DATE:
04/29/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Randal NewtonTIME COMPLETED:
02:41 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Executive Director Randal Newton and we discussed the purpose of the visit and elements of the complaint.

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

It was alleged that Staff 1 (S1) handled Resident 1 (R1) in a rough manner.(an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) It was reported that S1 grabbed both of R1's wrists and held them to R1's chest. It was also reported that S1 covered R1's mouth and nose with her hand. Interview with Staff 2 (S2) revealed on April 25, 2023 S2 was near the end of her shift when S1 asked her for assistance with changing R1. S2 stated they began to change R1 with Staff 3 (S3) also present in the room. R1 was not cooperating and began hitting and spitting on S1.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 08-AS-20230503155824
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 ASSISTED LIVING AT BONITA
FACILITY NUMBER: 374603394
VISIT DATE: 04/29/2024
NARRATIVE
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S2 stated that S1 became upset and forcibly grabbed both of R1's arms by R1's wrists. S2 stated that R1 screamed " you're gonna break my arms." S1 became angrier and covered R1's mouth, face and jaw with her hand. S2 stated that she told S1 to leave R1 alone but S1 continued and began cursing in spanish. Lastly, S1 grabbed a pillow and began forcing it on R1's face. S1 immediately removed the pillow after S2 demanded S1 to stop. S2 stated that in the end they used a different approach to change R1 and R1 was left on their bed to rest.

S1 is no longer employed by the facility and gave the following statement to law enforcement on April 28, 2023. S1 was the lead care manager on April 25, 2023 and asked S2 and S3 for assistance with changing R1. S1 stated that R1 had a history of being combative. S1 stated that R1 laid on their bed and began yelling " you're gonna kill me." S3 began changing R1 and R1 kicked S3. S1 stated she feared R1 was going to strike them with R1's hands so S1 grabbed R1's hands to restrain R1. R1 then began spitting on S1. S1 stated she "hovered" her hand over R1's mouth and told R1 "don't spit." S1 stated that S2 and S3 then exited the room. S1 then secured R1's pants and exited the room. S1 denied placing anything over R1's face.

LPA interviewed S3 who stated that she was asked by S1 to assist in changing R1. S3 stated that once in the room she was positioned at the feet of R1. S1 was positioned at the head and S2 was positioned in the middle of R1. S3 stated that she did not witness any rough behavior by S1 since S3 was blocked by a cabinet. S3 further stated that she did not recall hearing S1 curse in spanish because S3 was completely focused on changing R1's underpants.

LPA interviewed Executive Director (ED) who stated that she was initially unaware of the incident that took place. ED stated that on April 28, 2023 she was advised by S2 of the incident that occurred between S1 and R1. ED stated that S2 initially feared retaliation from S1 but ultimately felt it was her responsibility to report the incident. ED stated that after she was informed by S2 what occurred on April 25, 2023, she immediately contacted law enforcement.

Due to the lack of CCTV footage capturing the incident, the investigation relied heavily on witness testimonies and interviews with relevant parties. Additionally, it was discovered that law enforcement had been called to the facility on April 28, 2023 and a police report regarding the incident was filed. The police report filed on April 28, 2023 provided additional documentation and context regarding the incident.


SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20230503155824
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 ASSISTED LIVING AT BONITA
FACILITY NUMBER: 374603394
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2024
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from...abuse. This requirement was not met as evidenced by:
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S1 was terminated and licensee agreed to conduct a staff training regarding resident rights and redirecting.
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Based on interviews the licensee did not protect resident's personal right to be free from abuse in 1 of 67 persons in care ([R1]) which posed an immediate Safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20230503155824
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 ASSISTED LIVING AT BONITA
FACILITY NUMBER: 374603394
VISIT DATE: 04/29/2024
NARRATIVE
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Law enforcement report indicated that staff did not request paramedics and R1 was not seen by on site medical staff as R1 had no visible injuries and did not have any complaints of pain.

Based upon the foregoing, the above listed allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and is noted on the attached LIC 9099-D.

An exit interview was conducted with Randall Newton and a copy of this report and Licensee/Appeal Rights (LIC9058, 3/22) were provided to Randall Newton whose signature below confirms receipt of documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4