565802461-9-2-2021-29-AS-JAPL-C76M84-20210924092230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802461
Report Date: 09/01/2021
Date Signed: 09/02/2021 11:14:07 AM

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
08/27/2021 and conducted by Evaluator Teresa Camara

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210827144626

FACILITY NAME:	SUNRISE AT WOOD RANCH		FACILITY NUMBER:	565802461
ADMINISTRATOR:	EDITH KENNEDY		FACILITY TYPE:	740
ADDRESS:	190 TIERRA REJADA RD		TELEPHONE:	(805) 584-8881
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	100	CENSUS: 79	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Edith Kennedy		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was denied phone calls.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Teresa Camara and Ashley Smith arrived unannounced at 11:00 a.m. to conduct an initial complaint investigation visit. The LPAs met with Executive Director Edith Kennedy and explained the reason for the visit. During today's visit the LPAs conducted staff interviews at 11:15 a.m., 12:07 p.m. and 12:25 p.m., toured the facility at 11:40 a.m. and interviewed a family member of prosprective Resident 1 (R1) at 01:07 p.m. In addition, the LPAs gathered and reviewed pertinet documents.

Regarding the above allegation, it was alleged facility staff denied R1 phone calls. Based on the interviews conducted and records reviewed, LPAs confirmed R1 had toured and showed interest in moving into this facility but R1 never resided at this facility.

Based off the information obtained, the allegation is deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of this report was reviewed and issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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 1