502700532-2-28-2024-27-AS-LRIS-D4GW3P-20240419165614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700532
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:23:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20231220212315

FACILITY NAME:	SUNSHINE RESIDENTIAL II		FACILITY NUMBER:	502700532
ADMINISTRATOR:	AMOAH, MARY		FACILITY TYPE:	735
ADDRESS:	123 PEACH BLOSSOM LN		TELEPHONE:	(510) 935-8503
CITY:	PATTERSON	STATE: CA	ZIP CODE:	95363
CAPACITY:	6	CENSUS: 6	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator Dinah Ferolino		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff barricaded a door to prevent a client from leaving

Staff use inappropriate language towards a client

Staff are not addressing a client's medical needs while in care

Staff are mishandling a client's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Administrator Dinah Ferolino and explained the reason for the visit.

Staff barricaded a door to prevent a client from leaving - LPA Lund interviewed staff, and clients in care. Based on interviews with staff, and clients in care. Staff interviewed have never seen the doors barricaded at the facility. Clients interviewed stated that have never seen the doors barricaded at the facility.

Based on interviews with clients and staff on the information provided, it was unclear if Staff barricaded a door to prevent a client from leaving, therefore the allegation was deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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 3

Control Number 27-AS-20231220212315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL II	FACILITY NUMBER: 502700532
	VISIT DATE: 02/28/2024

NARRATIVE

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Staff use inappropriate language towards a client - LPA Lund reviewed staff records, interviewed staff, and clients in care. Staff get MAB workplace violence prevention & De-escalation training every two years. Staff interviewed stated that have not ever heard any staff use inappropriate language towards clients in care. Staff are trained to notify management if they were to hear any staff member use inappropriate language towards clients in care. Clients stated that staff have never seen staff use inappropriate language towards any clients in care.

Based on records review, interviews with clients and staff on the information provided, it was unclear if Staff use inappropriate language towards a client, therefore the allegation was deemed UNSUBSTANTIATED.

Staff are not addressing a client's medical needs while in care- LPA Lund reviewed staff records, interviewed staff, and clients in care. Based on Valley Mountain Regional Center Special Incident reports dated 1/18/2024 & 1/20/2024 C1 medical needs where being met. Interviews with staff, and clients in care medical needs where being met. Staff interviewed stated that if a client state they are not feeling well they will access the client and then call the clients doctor or take them to the Emergency room. Clients interviewed stated that their medical needs are being met from the facility.

Based on facility records review, interviews with clients and staff on the information provided, it was unclear if Staff are not addressing a client's medical needs while in care, therefore the allegation was deemed UNSUBSTANTIATED.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20231220212315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL II	FACILITY NUMBER: 502700532
	VISIT DATE: 02/28/2024

NARRATIVE

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Staff are mishandling a client's medication- LPA Lund reviewed three clients Medication Administration Record (MAR) for the months of October 2023 through February 2024 and found no discrepancies in the clients’ records. Staff are required to get medication training through Valley Mountain Regional Center. Trained staff get DSP 1 & DSP 2 certificates and then are able to dispense medication for clients in care. Staff interviewed stated that they have not mishandled any clients in care, and if so would notify management. Clients in care stated that they get their required medication from staff.

Based on facility records review, interviews with clients and staff on the information provided, it was unclear if staff are mishandling a client's medication, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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