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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045003003
Report Date: 03/13/2025
Date Signed: 03/13/2025 09:20:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2025 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20250218111654
FACILITY NAME:SUNSHINE ASSISTED LIVING- THE COTTAGEFACILITY NUMBER:
045003003
ADMINISTRATOR:FENNEL, LISAFACILITY TYPE:
740
ADDRESS:1468 SUN MANORTELEPHONE:
(530) 887-3363
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:17CENSUS: 9DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Edidha McCullrughTIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Staff tested a resident in care without permission

Staff did not keep the facility free of bed bugs

Staff did not safeguard a resident's personal belongings

INVESTIGATION FINDINGS:
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On 03/13/2025, Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Edidha McCullrugh and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.

LPA investigated the allegation, “Staff tested a resident in care without permission.” Based on interviews conducted, staff stated they asked residents for permission to be tested for an infectious disease. LPA interviewed R1 and resident stated she gave permission to facility staff to test resident for COVID-19.

---- Continued on LIC9099-C ----
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 2
Control Number 59-AS-20250218111654
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNSHINE ASSISTED LIVING- THE COTTAGE
FACILITY NUMBER: 045003003
VISIT DATE: 03/13/2025
NARRATIVE
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LPA investigated the allegation, “Staff did not keep the facility free of bed bugs.” Based on interviews and observation of facility records, it was stated the facility had a bed bug issue in the past and a local pest control company was contracted to provide monthly services. Records indicated the last bed bug infection was in December of 2024 and the pest control company has performed services monthly since then. The facility has no current issue with bed bugs and the local pest control company will continue to provide monthly services at the facility to spray for pests every month.

LPA investigated the allegation, “Staff did not safeguard a resident’s personal belongings.” Based on interviews and record review, staff members indicated they did not have any concerns regarding the safeguarding of resident’s personal belongings. Interview with R1 stated she did not have any concerns regarding safeguarding her personal belongings. LPA observed R1’s wheelchair that was lost and later found in R1’s room during the time of interview. R1 stated the wheelchair had been moved to another room but later brought back to R1 when found.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
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