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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700653
Report Date: 07/24/2023
Date Signed: 09/05/2023 12:35:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
05/15/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230515130640
FACILITY NAME:SUNSHINE RESIDENTIAL IIIFACILITY NUMBER:
502700653
ADMINISTRATOR:AMOAH, MARYFACILITY TYPE:
735
ADDRESS:1233 FAWN LILY DRIVETELEPHONE:
(510) 935-8503
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY:6CENSUS: 4DATE:
07/24/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Mary Amoah, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility doorway is not free from obstruction
Food is inaccessible to residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT IS AN AMENDMENT OF THE VERBIAGE FOUND IN THE PRIOR LIC9099 AND THIS NEW 9099 NOW SUPERSEDES IT.

On 07/24/2023, Licensing Program Analyst Renee Campbell arrived at Sunshine Care Home III to deliver findings for complaint 27-AS-20230515130640. LPA met with Direct Service Providers (DSP) Ramon Howard and Ekoti Ingi, and 15 mins later, met with Administrator Mary Amoah and explained the purpose of the visit. The investigation was conducted by the Department which consisted of a review of records, observations and interviews.

Regarding allegation, "Facility doorway is not free from obstruction", during interviews, staff and administrator admitted that the facility had pushed furniture in front of the door to prevent a resident from leaving at night. In regards to the allegation, "Food is inaccessible to residents in care.", both staff and the administrator confirmed that a chain had been placed around the refrigirator to dissuade residents from accessing it after meals.

Based on interviews with staff and the administrator confirming that allegations were true, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED. per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC-9099D. Appeal rights were provided. An exit interview was conducted, and a copy of the report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
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-20230515130640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUNSHINE RESIDENTIAL III
FACILITY NUMBER: 502700653
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
80072(7)
1
2
3
4
5
6
7
Personal Rights: (7) Not to be locked in any room, building, or facility premises by day or night.


This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator will review section 80072(7) of the regulations and provide LPA a written statement acknowleding the importance of not preventing clients from leaving of their own free will.
8
9
10
11
12
13
14
Based on interviews, the administrator admitted that couches and chairs had been used to block the main entrance of the facility to prevent resident elopement.
This poses a potential health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
07/28/2023
Section Cited
CCR
80072(2)
1
2
3
4
5
6
7
Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will conduct an in-service training of regulation 80072 in relation to allowing residents to have access to the refrigerator. Licensee will submit a training overview with a list of the topics to be covered as well as a sign in sheet for the staff who attended.
8
9
10
11
12
13
14
Based on interviews, the client was not provided healthful accommodations due to having a chain around the refrigerator.

This poses a potential Health, Safety or Personal Rights risk.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2