565801682-7-12-2021-29-AS-JAPL-C57UBR-20210723152647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801682
Report Date: 07/12/2021
Date Signed: 07/12/2021 02:07:52 PM

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
06/03/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20210603101611

FACILITY NAME:	SUNSHINE HEALTH PLACE		FACILITY NUMBER:	565801682
ADMINISTRATOR:	SLIM MARON		FACILITY TYPE:	740
ADDRESS:	1558 NORMAN AVENUE		TELEPHONE:	(805) 446-3100
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	07/12/2021
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Cilva Toume		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff are sexually abusing resident.
Facility staff are physically abusing resident.
Facility staff are mentally abusing resident.
Facility staff are putting glass in resident's food.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ashley Smith and Salia Walker arrived unannounced for a subsequent complanit visit to deliver findings for the above allegations. The LPAs met with Administrator Cilva Toume and explained the reason for the visit.

On 06/03/2021, the Department received a complaint, alleging that facility staff were abusing Resident #1 (R1) sexually, physically, and mentally. It was also alleged that the staff were grinding up glass and putting it in R1’s food. LPA Zabel Chochian conducted the initial visit on 06/07/2021 and during that visit, interviewed five residents and reviewed records from 12:30 p.m. to 1:30 p.m.. LPA Smith conducted a subsequent visit on 06/25/2021 and interviewed six residents from 9:35 a.m. – 10:45 a.m., and interviewed staff at 9:54 a.m., and 11:02 a.m., and 11:16 a.m.. Also, the LPA interviewed a family member for R1 on 6/22/2021 at 5:05 p.m..

CONT 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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 4

Control Number 29-AS-20210603101611

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: SUNSHINE HEALTH PLACE	FACILITY NUMBER: 565801682
	VISIT DATE: 07/12/2021

NARRATIVE

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Regarding the allegation: Facility staff are sexually abusing resident
It was alleged that staff were going into R1’s room at night and sexually abusing R1. The interview with R1 revealed varying statements in which R1 did not identify whom was harming R1, as R1 stated that it happened while they were in a deep sleep. When asked if they were touched inappropriately, R1 claimed that they did not ‘blame anyone’ in the home and did not reference any encounters but believed that a staff in the home was sexually attracted to them. R1’s family member stated that they were comfortable with R1 residing in this facility and stated that due to R1’s mental health diagnosis, R1’s family member believed that R1’s claims have the potential to lack validity. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care.

Interviews conducted with staff revealed that they have not observed their coworkers acting inappropriately with residents, and were trained to report all types of abuse, both observed, overheard, and/or disclosed. Staff denied all claims that they were physically, sexually, or mentally abusing any resident in this facility. Resident interviews revealed that residents felt comfortable residing in this facility and confirmed that they observed appropriate interactions from the staff.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff were sexually abusing R1. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility staff are physically abusing resident.
It was alleged that staff physically abused R1, which resulted in R1 sustaining a broken jaw. When asked if they had been harmed, R1 made claims that they believed that they had a broken jaw and that it happened while they were asleep. However, R1 was unable to specify who harmed them. Interviews and records review confirmed that R1 never suffered a broken jaw while residing at this facility. R1’s family member stated that they were comfortable with R1 residing in this facility, had never witnessed unexplained bruising on R1, and confirmed that due to R1’s mental health diagnosis, believed that R1’s claims have the potential to lack validity. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care.
Additional resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents denied claims of abuse from staff and stated that staff maintained appropriate relationships and boundaries with the residents.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210603101611

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: SUNSHINE HEALTH PLACE	FACILITY NUMBER: 565801682
	VISIT DATE: 07/12/2021

NARRATIVE

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Interviews conducted with staff revealed that they have not observed their coworkers acting inappropriately with residents, and were trained to report all types of abuse, both observed, overheard, and/or disclosed. Staff interviews revealed that if R1 communicated any ailments that they would conduct body checks to assess for any unexplained bruising. The Administrator stated that they trust the staff working alongside the residents and denied having any knowledge of any incidents of abuse in this facility.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff were physically abusing R1. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility staff are mentally abusing resident.
It was alleged that facility staff were disrespecting R1, by not listening to R1 when they communicate concerns. During the 6/25/2021 visit, the LPA observed staff appropriately interacting with R1 and were responsive to R1’s claims and needs. The LPA did not observe staff yelling, negating R1’s claims, nor did the LPA observe staff dismiss any of R1’s claims. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care. Resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents stated that R1 was also treated well but admitted that R1 would sometimes get into verbal altercations with staff, make false accusations against staff and would often call 9-1-1. However, residents stated that R1’s behaviors were observed to be independent from any negative or adverse interaction from staff.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff were mentally abusing R1. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility staff are putting glass in resident's food.
It was alleged that staff were putting glass in R1’s food. When questioned about food service in the home, R1 had complimentary things to say in regard to their preferred meals, and stated that staff would follow their dietary restrictions. Whereas R1 denied claims that glass was being placed in the food, R1 stated that there was ‘something wrong’ with the food yet did not elaborate when questioned. If anything, R1 claimed that the medication they took had affected their stomach. R1’s family member stated that they were comfortable with R1 residing in this facility and confirmed that due to R1’s mental health diagnosis, believed that R1’s claims have the potential to lack validity.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20210603101611

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: SUNSHINE HEALTH PLACE	FACILITY NUMBER: 565801682
	VISIT DATE: 07/12/2021

NARRATIVE

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Additional resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents negated claims that items were being placed in the food and communicated that they were being fed well. Lastly, staff denied claims that glass or other foreign objects were placed in R1’s food, and confirmed that they upheld all dietary preferences for the residents.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff are putting glass in R1’s food. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC9099 (FAS) - (06/04)

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