<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700532
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:58:06 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, 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
08/04/2021 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20210804133935
FACILITY NAME:SUNSHINE RESIDENTIAL IIFACILITY NUMBER:
502700532
ADMINISTRATOR:AMOAH, MARYFACILITY TYPE:
735
ADDRESS:123 PEACH BLOSSOM LNTELEPHONE:
(510) 935-8503
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY:6CENSUS: 5DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Mary AmoahTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's hygiene needs are not being met
Staff is unable to effectively communicate
Staff did not safeguard resident's oral hygiene products
Staff did not properly care for resident's skin condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Jason Lund arrived at the facility unannounced to deliver findings for the above complaint allegations. LPA Lund met with Administrator Mary Amoah and explained the reason for the visit.

Based on records review, interviews with staff and witness it was determined that the Administrator and Caregivers attempted to meet Client (C1) hygiene needs (Showers). C1 would have behavior’s and hit staff and residents and would not take showers. Staff did use wipes until C1’s mom came and help staff have C1 take shower. C1 would constantly scratch C1’s back and staff would attempt to the put lotion of C1’s back but, C1’s behaviors would not allow staff to properly put on the lotion. C1’s IPP (individual program plan) dated 8/2020 does show that C1 displays aggression, frustration, self-injurious behaviors, property destruction and emotional outburst.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
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 2
Control Number 27-AS-20210804133935
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: SUNSHINE RESIDENTIAL II
FACILITY NUMBER: 502700532
VISIT DATE: 02/18/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews with staff and witness C1 is non-verbal and uses gestures to communicate with Staff and Family. C1 is not able to verbally tell C1 needs to staff. Staff had to learn to prompt (Communicate) with C1 to do thangs the staff would ask C1 to do and with C1’s behaviors make it hard to properly communicate with C1.

During the investigation LPA Lund observed centrally stored and independent stored hygiene products for clients. LPA could not verify if another client used another clients hygiene products.

This agency has investigated the above listed allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, we have found the allegation to be UNSUBSTANTIATED.

Exit interview held and copy of report given at the conclusion of this visit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2