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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801931
Report Date: 08/14/2024
Date Signed: 08/14/2024 05:14:45 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
09/14/2023 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20230914170537
FACILITY NAME:SUNSHINE HEALTH PLACE 2FACILITY NUMBER:
565801931
ADMINISTRATOR:SAM MARONFACILITY TYPE:
740
ADDRESS:1482 NORMAN AVENUETELEPHONE:
(805) 304-5960
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
08/14/2024
UNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Vana BarberisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained multiple falls while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA met with back-up administrator Vana Barberis and explained the reason for the visit.
On 9/18/2023, LPA Elsie Campos started this investigation by conducting interviews with administrator, residents and collecting documentation. On 8/14/2024, LPA Camara conducted a telephone interview with a witness, interviewed staff at 11:46 a.m., and collected more documentation at 11:54 a.m. Residet 1 (R1) fell in August 2023 while using a walker and being assisted by R1's spouse. It was suspected R1 may have had a cardiovascular event which caused the fall but that was never clearly determined by R1's physician. When R1 fell, staff were nearby but not close enough to catch R1. According to staff, prior to R1's fall, R1 was able to walk with standby assistance and a walker. At this time, R1's physical condition has deteriorated and R1 can no longer walk. Witness and Staff stated R1 fell only once at this facility. Based on the information gathered, the allegation R1 sustained multiple falls while in care is deemed Unsubstantiated at this time. Exit interview conducted and report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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