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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045003003
Report Date: 07/24/2025
Date Signed: 07/29/2025 09:19:28 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
04/25/2025 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20250425115517
FACILITY NAME:SUNSHINE ASSISTED LIVING- THE COTTAGEFACILITY NUMBER:
045003003
ADMINISTRATOR:FOZ, MERYLFACILITY TYPE:
740
ADDRESS:1468 SUN MANORTELEPHONE:
(530) 887-3363
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:17CENSUS: 12DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anthony FaulknerTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility staff do not provide food to meet resident’s restricted food dietary needs
Facility staff illegally evicted resident
INVESTIGATION FINDINGS:
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On July 24, 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 Administrator Anthony Faulkner and explained the purpose of the visit.

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

LPA investigated the allegation, “Facility staff do not provide food to meet resident’s restricted food dietary needs.” Based on interviews it was indicated that R1 was offered multiple food options during meals. Interviews stated that R1 was given food to meet R1's dietary needs and R1 would decline food when R1 did not like the food provided. Staff stated that R1 was given other food options and made sure R1 did not skip a meal. LPA could not corroborate the allegation.

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

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20250425115517
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: 07/24/2025
NARRATIVE
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LPA investigated the allegation, “Facility staff illegally evicted resident.” Based on interviews conducted and record review, it was indicated that R1 moved voluntarily from the facility. Facility staff had candid discussions with R1's representative regarding R1’s desire to move. It was also learned that the facility did not issue any eviction notice to R1.

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: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2