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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603437
Report Date: 03/27/2026
Date Signed: 03/27/2026 06:29:42 PM

Document Has Been Signed on 03/27/2026 06:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SUNGARDEN TERRACEFACILITY NUMBER:
374603437
ADMINISTRATOR/
DIRECTOR:		SUSAN O'SHAUGHNESSYFACILITY TYPE:
740
ADDRESS:2045 SKYLINE DRIVETELEPHONE:
(619) 462-5831
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 110CENSUS: 49DATE:
03/27/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrative Assistant Jasmine Ybarra and Administrator Susan O’ShaughnessyTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrative Assistant Jasmine Ybarra. LPA then met with Administrator Susan O’Shaughnessy, who arrived shortly after.

According to the facility’s license, the facility has a maximum capacity for one-hundred-ten (110) residents, of whom all may be ambulatory or non-ambulatory, and up to ten (10) may be bedridden. Also, up to twenty (20) of the residents may be under hospice care at any given time. Per LPA observation, LIC602 Physician’s Reports, and manager interviews: During today’s inspection, there were a total of forty-nine (49) residents in care, of whom thirty-four (34) were non-ambulatory, and one (1) was bedridden. Also, eight (8) of the residents were under hospice care. The facility’s license and fire clearance allowed for the use of locked perimeter doors in the memory care unit, and such doors were compliant with this stipulation.

LPA reviewed records for multiple residents and multiple staff. LPA interviewed multiple staff. LPA, accompanied by the administrator, also toured the interior and exterior of the facility, and inspected all common areas and multiple resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 75 F. [CONTINUED ON LIC 809-C, 1 of 2]
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNGARDEN TERRACE
FACILITY NUMBER: 374603437
VISIT DATE: 03/27/2026
NARRATIVE
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[CONTINUED FROM LIC 809]

Where tested, hot water temperature at taps accessible to residents were compliant. Appliances to preserve perishable food were also all compliant in temperature: Main Walk-In Refrigerator was 37.7 F. Main Walk-In Freezer was 0 F. The Medication Room Refrigerator was also complaint in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present.

There were no sharp objects, toxic chemicals/poisons or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No fireplaces or pools (or similar bodies of water) were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detectors, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. Licensee presented proof of current business liability insurance.

During a review of records, LPA observed, and manager interview confirmed: For 1 of 5 sampled residents [Resident #1 (R1)] Licensee did not possess proof/documentation that the resident had a negative tuberculosis test result or chest X-ray, as was required to be on file before the resident’s move in. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] For 4 of 5 sampled residents [Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5)], Licensee did not have as part of the resident’s record the name, address, and telephone number of a dentist to be called in an emergency, as required. For R2, Licensee also did not have as part of resident’s record the name, address, and telephone number of a physician to be called in an emergency, as required. Licensee did not have proof/documentation that within the last twelve (12) months, they held a meeting/conference with the responsible person and other appropriate parties for 5 of 5 sampled residents (R1 through R5), for the purpose of reviewing and updating the resident’s written record of care / care plan, as was required.

[CONTINUED ON LIC 809-C, 2 of 2]
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNGARDEN TERRACE
FACILITY NUMBER: 374603437
VISIT DATE: 03/27/2026
NARRATIVE
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[CONTINUED FROM LIC 809-C, 1 of 2]

Licensee did not possess an LIC610E Emergency and Disaster Plan that met current regulatory requirements. Licensee also did not possess documentation demonstrating that either a consultant pharmacist or nurse had reviewed the facility’s medication management program and procedures at least twice per year, which is a requirement for residential care facilities for the elderly licensed to provide care for 16 or more persons.

Three (3) deficiencies were cited per California Code of Regulations, Title 22, and two (2) deficiencies were cited per California Health and Safety Code (refer to the attached LIC809-D pages). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Administrator Susan O’Shaughnessy, to whom a copy of this report, the LIC 809-D pages, and the LIC811 Confidential Names List were provided during today’s visit.
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 03/27/2026 06:29 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/27/2026 at 05:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNGARDEN TERRACE
FACILITY NUMBER: 374603437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.69(g)
Other Provisions
(g) Residential care facilities for the elderly licensed to provide care for 16 or more persons shall maintain documentation that demonstrates that a consultant pharmacist or nurse has reviewed the facility’s medication management program and procedures at least twice a year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review and manager interview, Licensee's facility is licensed for more than 16 residents, but Licensee did not maintain documentation that a consultant pharmacist or nurse had reviewed the facility's medication management program and procedures at least twice per year. This posed a potential health risk to 49 of 49 residents (R1 through Resident #49) in care.
POC Due Date: 04/27/2026
Plan of Correction
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3
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Licensee agreed to either hire a Resident Services Director who is a currently a licensed nurse in California, or to retain the services of a consultant pharmacist or nurse to review the facility's medication management program and procedures at least twice per year. Licensee agreed to E-mail proof that either a nurse has been hired to join the facility's team, or that an outside consultant pharmacist/nurse has been performed the review, by the POC due date.
Type B
Section Cited
CCR
87506(b)(9)
Resident Records
(b) Each resident's record shall contain at least the following information: (9) Name, address and telephone number of physician and dentist to be called in an emergency.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview: For 4 of 5 sampled residents (R2 through R5), Licensee did not have in their record of care the name, address, and telephone number of a dentist to be called in an emergency. For 1 of 5 sampled residents (R2), Licensee did not have in their record of care the name, address, and telephone number of a physician to be called in an emergency.This posed a potential health risk to persons in care.
POC Due Date: 04/27/2026
Plan of Correction
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2
3
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Licensee agreed to communicate with necessary parties to update the Facesheets for R2 through R5. If a resident does not have a preferred physician and/or dentist, Licensee may list a default mobile professional who can be called for emergencies, until a preferred one is provided. Licensee agreed to E-mail the updated Facesheets for R2 through R5 to LPA, by the POC due date. Licensee agreed to self-audit remaining Facesheets for physician and dentist information.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2026


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 03/27/2026 06:29 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/27/2026 at 05:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNGARDEN TERRACE
FACILITY NUMBER: 374603437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87458(c)(1)(A)
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, Licensee did not ensure that the pre-admission medical assessment for 1 of 5 sampled residents (R1) included the test results of an examination for communicable tuberculosis. This posted a potential health risk to persons in care.
POC Due Date: 04/27/2026
Plan of Correction
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Licensee agreed to coordinate with R1’s current physician and/or hospice agency to have a PPD skin test or chest x-ray performed on R1. Licensee agreed to E-mail the negative tuberculosis (TB) test result to LPA, by the POC due date. Licensee agreed to self-audit all remaining client records to ensure complete TB records are on file.
Type B
Section Cited
HSC
1569.695(a)
1569.695 Emergency Plans: “(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following…” This requirement was not met, as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, Licensee did not have an emergency and disaster plan for hte facility that met regulatory requirements. This posed a potential safety risk to 49 of 49 residents (R1 through Resident #49) in care.
POC Due Date: 04/27/2026
Plan of Correction
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Licensee agreed to complete all pages of form LIC610E (version 3/19), and E-mail a copy of it to LPA, by the POC due date. Going forward, Licensee agreed to train all staff on this document, both at time of hire and at least annually thereafter.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2026


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 03/27/2026 06:29 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/27/2026 at 05:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNGARDEN TERRACE
FACILITY NUMBER: 374603437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87467(a)(3)
Resident Participation in Decisionmaking
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
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Based on records review and manager interview, for 5 of 5 residents (R1 through R5), Licensee did not within the last 12 months arrange a meeting with the resident and required individuals to review and revise the resident's written record of care. This posed a potential health risk to persons in care.
POC Due Date: 04/27/2026
Plan of Correction
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For R1 through R5 each, Licensee agreed to conduct a care conference with their responsible person (and visiting care agency personnel, as applicable) to review the resident's facility Plan of Care, updating it as needed. All parties to the meeting will sign. Licensee agreed to E-mail proof of care conference completion to LPA, by the POC due date. Going forward, Licensee agreed to facilitate such care conferences at least once every 12 months for each resident.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2026


LIC809 (FAS) - (06/04)
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