565801625-6-19-2025-29-AS-KHEN-DJZSTZ-20250728141023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801625
Report Date: 06/19/2025
Date Signed: 06/19/2025 12:59:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/16/2025 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20250616112427

FACILITY NAME:	SUNRISE MANOR, LLC		FACILITY NUMBER:	565801625
ADMINISTRATOR:	JULIANA ANOS		FACILITY TYPE:	735
ADDRESS:	441 WEST CHANNEL ISLAND BLVD		TELEPHONE:	(805) 240-7600
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	60	CENSUS: 47	DATE:	06/19/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Stacey Medina, Administrator		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Due to lack of supervision, resident hit another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:00 a.m., the LPA with Administrator, Stacey Medina and explained the reason for the visit.

Between 9:02 a.m. and 12:08 p.m., the LPA conducted interviews with three (3) staff and eight (8) clients. At 9:39 a.m., the LPA, along with the Administrator Assistant, Cathalina Anos-Hipolito conducted a physical plant tour. At 12:25 p.m., the LPA requested and obtained copies of pertinent documents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250616112427

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE MANOR, LLC	FACILITY NUMBER: 565801625
	VISIT DATE: 06/19/2025

NARRATIVE

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Regarding the allegation: 1.) Due to lack of supervision, resident hit another resident while in care. On 06/16/2025, the Department received a complaint alleging Resident #1 (R1) was hit by Resident #2 (R2) while at the facility. Interviews with Administrator Stacey Medina and Cathalina Anos-Hioplito revealed that on 06/10/2025, R1 told Staff #1 (S1) that R1 wanted to go to the hospital due to having suicidal ideations. R1 was taken to the hospital the same day. Interview with Stacy M. and Cathalina A. revealed that they were not aware of any resident hitting R1 until they received a call from R1’s family member on 06/12/2025. Since being notified of the alleged incident, Stacey M. and Cathalina A. have conducted interviews with staff and residents. Stacy M. stated that from their interviews it was revealed that Resident #3 (R3) was also an alleged perpetrator as R3 was joking with R1 and did a hand motion towards R1. During todays visit, the LPA conducted interviews with R2 and R3, which both denied hitting R1. Conflicting information was obtained from the interviews conducted with residents and staff regarding the alleged incident. There were no witnesses to the alleged incident. Staff interviews revealed that residents sometimes have verbal arguments but rarely have physical altercations. Staff interviews stated that staff do intervene if there are any issues amongst residents. Additionally, resident interviews did not voice any safety concerns. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

LIC9099 (FAS) - (06/04)

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