374603437-5-19-2023-08-AS-DPOL-CT9PJP-20230629112151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603437
Report Date: 05/19/2023
Date Signed: 05/19/2023 02:24:30 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
09/10/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210910164640

FACILITY NAME:	SUNGARDEN TERRACE		FACILITY NUMBER:	374603437
ADMINISTRATOR:	LOVERDE, MELISSA		FACILITY TYPE:	740
ADDRESS:	2045 SKYLINE DRIVE		TELEPHONE:	(619) 462-5831
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	110	CENSUS: 49	DATE:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Susan O'shaughnessy, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Appropriate measures were not put into place for resident who is a fall risk.
Facility does not provide resident with activities.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Susan O'shaughnessy, Administrator to discuss the purpose of the visit.

LPA conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that appropriate measures were not put into place for a resident who is a fall risk. Interviews revealed that staff supervise the residents at all times. Interviews revealed that when residents are in their rooms the staff do rounds and check on the residents but there is not a staff assigned to each room to supervise each resident. Interviews revealed that since this is a memory care unit that some residents still floated around and would be in the dining area as well.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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-20210910164640

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: SUNGARDEN TERRACE	FACILITY NUMBER: 374603437
	VISIT DATE: 05/19/2023

NARRATIVE

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Interviews revealed the memory care is always locked for the residents safety and there is always enough staff to assist the residents.

It was alleged that facility does not provide resident with activities. Interviews revealed that there are activities out for the residents and the staff remind them and show them and also sit down and do activities with them. Interviews revealed most residents want to sit and watch television or listen to music. Some draw and some play cards. There are others that do puzzles and color. Interviews revealed they cannot make the residents do activities when they are offered if they don't want to.

The investigation did not produce supporting evidence or supporting witness statements to substantiate appropriate measures were not put into place for a resident who is a fall risk and facility does not provide resident with activities.
Based on the evidence obtained from interviews, and record review, the complaint allegations are unsubstantiated.

An exit interview was conducted with Susan O'shaughnessy, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

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