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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801625
Report Date: 03/01/2023
Date Signed: 03/01/2023 01:40:31 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230228140034
FACILITY NAME:SUNRISE MANOR, LLCFACILITY NUMBER:
565801625
ADMINISTRATOR:JULIANA ANOSFACILITY TYPE:
735
ADDRESS:441 WEST CHANNEL ISLAND BLVDTELEPHONE:
(805) 240-7600
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:60CENSUS: 55DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Julie AnosTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility has pests
INVESTIGATION FINDINGS:
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Licesnsing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today regarding the above allegations. The LPA met with Administrator Julie Anos and explained the reason for the inspection.

During today's inspection, the LPA observed Client #1's (C1) room and conducted an interview with C1 at 11:52 AM. The LPA also conducted interviews with the Administrator during the inspection and with Staff #1 (S1) at 12:11 AM.

The allegation of Facility has pests alleges there are bedbugs in the room of C1. Interviews with the Administrator revealed the facility has a history of bed bugs but they treat monthly with a pest control company and spray the bedrooms and clean the bedding of rooms observed with bedbugs by house keeping in the interim. Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 5
Control Number 29-AS-20230228140034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE MANOR, LLC
FACILITY NUMBER: 565801625
VISIT DATE: 03/01/2023
NARRATIVE
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Interviews with S1 revealed that C1 had reported to the overnight shift on 02/28/2023, that their roommate had bed bugs and S1 was advised when they arrived to work at 7:10 AM. S1 stated they observed the room and observed the roommate to have bedbugs on their side of the room but did not observe any bed bugs on C1's side of the room. S1 instructed house keeping to spray the walls, both beds with over the counter bed bug spray and to remove the bedding of both clients. S1 stated the day program also then called to report that C1 has bed bugs in their bedroom and returned C1 back to the facility. S1 stated they advised the day program that they were aware and treated the room. Interviews with the Administrator and S1 revealed the room has had a history of bed bugs that they have been treating. LPA requested to see invoices/receipts of the monthly pest service being provided but the Licensee was not able to provide during the inspection as they were not at home. The Licensee stated they would fax the receipts to the LPA.

Based on the information obtained there is sufficient evidence to support the allegation of "Facility has pests". Therefore, the allegation is deemed Substantiated at this time.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230228140034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE MANOR, LLC
FACILITY NUMBER: 565801625
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met as evidenced by:
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The Administrator agreed to have C1's room serviced by the pest control company in addition to the regular monthly service. The Administrator stated they called the pest control company and they are coming out tomorrow to treat the room. Proof shall be submitted to CCL by 03/13/2023.
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Based on interviews, the licensee failed to comply with the section cited above as staff observed bed bugs in the bedroom of C1 which poses a potential health and personal rights risk to persons in care.
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 LPA also requests proof/invoices that the facility is receiving a regularly scheduled monthly service by 03/13/2023.
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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.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230228140034

FACILITY NAME:SUNRISE MANOR, LLCFACILITY NUMBER:
565801625
ADMINISTRATOR:JULIANA ANOSFACILITY TYPE:
735
ADDRESS:441 WEST CHANNEL ISLAND BLVDTELEPHONE:
(805) 240-7600
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:60CENSUS: 55DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Julie AnosTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility staff yelled at client
Facility staff made inappropriate comments to client
Facility staff is retaliating against client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today regarding the above allegations. The LPA met with Administrator Julie Anos and explained the reason for the inspection.

During today's inspection, the LPA observed Client #1's (C1) room and conducted an interview with C1 at 11:52 AM. The LPA also conducted interviews with the Administrator during the inspection and with Staff #1 (S1) at 12:11 PM.

The allegation of 'Facility staff yelled at client' and 'Facility staff made inappropriate comments to client', alleges S1 yelled at C1 for reporting to their day program that their room had bed bugs and S1 told C1 it was their fault they could not attend day program on their birthday and they need to learn to stay quiet.
Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 5
Control Number 29-AS-20230228140034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE MANOR, LLC
FACILITY NUMBER: 565801625
VISIT DATE: 03/01/2023
NARRATIVE
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During the interview with C1, C1 stated S1 did not yell at C1 but was upset with C1 for reporting the bedbugs to the day program and told C1 they should have not reported the bed bugs. During the interview with S1, S1 denied yelling at C1 or being upset with C1 for reporting the bed bugs and denied telling C1 it was their fault for not being able to attend day program and to learn to stay quiet. Based on the information obtained, there is insufficient evidence to support the allegations of 'Facility staff yelled at client' and 'Facility staff made inappropriate comments to client' occurred. Therefore, the allegations are deemed unsubstantiated at this time.

The allegation of 'Facility staff is retaliating against client' alleged S1 was retaliating by refusing to contact C1's day program and a write letter stating services were completed for bed bugs so C1 can resume attendance due to C1 reporting bed bugs. During the interview with S1, S1 denied retaliating against C1. They said yesterday, 02/28/2023 was a busy day for S1, but they were able to type the letter and fax it to the day program in the afternoon. The LPA was given a copy of a letter dated 02/28/2023, signed by Administrator Juliana Anos indicating a bed bug treatment was conducted in C1's bedroom. Based on the information obtained, there is insufficient evidence to support the allegation of 'Facility staff is retaliating against client' occurred. Therefore, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5