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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397002682
Report Date: 08/15/2022
Date Signed: 08/15/2022 01:44:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220804090523
FACILITY NAME:SUNNY PLACE OF STOCKTONFACILITY NUMBER:
397002682
ADMINISTRATOR:EXPECTACIO VIERRAFACILITY TYPE:
740
ADDRESS:807 WEST SWAIN ROADTELEPHONE:
(209) 956-8677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:18CENSUS: 9DATE:
08/15/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Expectacio VierraTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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On 8/15/22 at 10:45am Licensing Program Analyst (LPA) Maja Jensen arrived at facility to continue an investigation in to the above allegation. LPA Jensen met with Expectacio Vierra and explained the purpose of today's visit.

During the course of the investigation, LPA Jensen reviewed records including Physician reports, staff roster, staff schedule and chart notes for resident 1 (R1). LPA Jensen also interviewed Administrator/Licensee who confirmed that client R1 went in to hospital and then a skilled nursing facility at which time the Licensee instructed the resident's Power of Attorney that the client cannot return to the facility due to challenges that had been encountered with her care. The licensee verified that no eviction letter had been issued. Based on the Licensee's admission that the resident is not being permitted to return and Licensee's admission that no eviction letter was issued the preponderance of evidence standard has been met and the allegation of illegal eviction is SUBSTANTIATED.

Continued on LIC 9099C...


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
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 27-AS-20220804090523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SUNNY PLACE OF STOCKTON
FACILITY NUMBER: 397002682
VISIT DATE: 08/15/2022
NARRATIVE
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Deficiencies are being cited today from the California Code of Regulations (CCRs) Title 22, Division 6, Chapter 8. A civil penalty in the amount of $250 is also being assessed for repeat violations.

An exit interview was conducted and a copy of this report and appeal rights were provided to Licensee.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220804090523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNNY PLACE OF STOCKTON
FACILITY NUMBER: 397002682
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/17/2022
Section Cited
CCR
87224(a)
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87224 Eviction Procedures

(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...

This requirement was not met as evidenced by:
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The Licensee agrees to submit via email a written attestation indicating that the regulation was read, understood and will be obliged by to maja.jensen@dss.ca.gov
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Based on the interview with Licensee and the Licensee's admission that the POA was informed that R1 cannot return to the facility and the Licensee's confirmation that no eviction notice was served. This poses a potential risk to the health, safety and personal rights of residents 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: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220804090523

FACILITY NAME:SUNNY PLACE OF STOCKTONFACILITY NUMBER:
397002682
ADMINISTRATOR:EXPECTACIO VIERRAFACILITY TYPE:
740
ADDRESS:807 WEST SWAIN ROADTELEPHONE:
(209) 956-8677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:18CENSUS: 9DATE:
08/15/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Expectacio VierraTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility serves food of low quality
INVESTIGATION FINDINGS:
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On 8/15/22 at 10:45am Licensing Program Analyst (LPA) Maja Jensen arrived at facility to continue an investigation in to the above allegation. LPA Jensen met with Expectacio Vierra and explained the purpose of today's visit.

During the course of the investigation, LPA Jensen reviewed the weekly meal calendar, and toured the kitchen. The facility was observed to have two days of perishable food and 7 days of non-perishable food. Lunch service was observed. Pasta with shrimp, a side of broccoli and cake for dessert was being served. Fresh fruit was observed in the dining hall and included apples, oranges, bananas and various melons which were accessible to residents in care. LPA Jensen also interviewed 2 residents and 2 staff members. Although the allegation may have occurred as reported there was insufficient evidence to prove the allegation. The preponderance of evidence standard was not met therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report with appeal rights was given to Licensee.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4