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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397002740
Report Date: 08/17/2021
Date Signed: 11/05/2021 04:06:52 PM



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
07/20/2021 and conducted by Evaluator Ashley Boothe
COMPLAINT CONTROL NUMBER: 27-AS-20210720113955
FACILITY NAME:SUNRISE HOMESFACILITY NUMBER:
397002740
ADMINISTRATOR:ELIZABETH ABESAFACILITY TYPE:
740
ADDRESS:8100 S. BRIGHT ROADTELEPHONE:
(209) 234-2550
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:15CENSUS: 10DATE:
08/17/2021
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Elizabeth AbesaTIME COMPLETED:
09:10 AM
ALLEGATION(S):
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9
Facility is cashing resident's checks after declining resident to return to facility.
INVESTIGATION FINDINGS:
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13
On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver an amendment of complaint investigation findings with the following allegations: Facility is cashing resident's checks after declining resident to return to facility. LPA met with Elizabeth Abesa and stated the purpose of the visit. Today's Census 10.

This is an amendment of 9099 report delivered to Elizabeth Abesa by LPA Ashley Boothe on 8/17/2021. A new 9099 was created as the findings were changed. The new 9099 supersedes the previous report.
Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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 2
Control Number 27-AS-20210720113955
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: SUNRISE HOMES
FACILITY NUMBER: 397002740
VISIT DATE: 08/17/2021
NARRATIVE
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This is an amendment of 9099 report delivered to Elizabeth Abesa by LPA Ashley Boothe on 8/17/2021. A new 9099 was created as the findings were changed. The new 9099 supersedes the previous report.

Page 2 of 2.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2