<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606841
Report Date: 08/18/2021
Date Signed: 08/18/2021 03:27:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2021 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210727142224
FACILITY NAME:SUNNYSIDE GUEST HOMEFACILITY NUMBER:
197606841
ADMINISTRATOR:RICHARD VILLAVERDEFACILITY TYPE:
740
ADDRESS:4457 N. MAXSON ROADTELEPHONE:
(626) 443-9529
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:12CENSUS: 10DATE:
08/18/2021
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Richard VillaverdeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injuries while in care.
Resident is mistreated by staff.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Glenn Trueman made a visit to the facility and was greeted by Caregiver Marissa Barajas and explained the reason for the visit.
Shortly thereafter Administrator Richard Villaverde arrived.
The purpose of the visit is to conduct a subsequent complaint visit from the original complaint dated 7/27/21.
Today's investigation consisted of the following:
Staff and Resident Roster was submitted.
Staff S1 and S 2 were interviewed from 930 AM to 1015 AM.
Client C 2 was interviewed from 10:15 AM to 1030 AM.
Initial visit was conducted on 7/28/21 and a Health and Safety Check was done.
Subsequent visit was done on 8/10/21 and Staff S1-S 3 were interviewed from 945 AM to 1100 AM.
Client C 1- C 3 were interviewed from 11:00 AM to 11:30 AM.
In regards to the allegation Resident sustained injuries while in care, based on interviews conducted and information gathered Client 1 stated that she leaves the facility by herself to the mall and she goes herself.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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 2
Control Number 28-AS-20210727142224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SUNNYSIDE GUEST HOME
FACILITY NUMBER: 197606841
VISIT DATE: 08/18/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Stated that Staff try to help her and that S 1 helped her and that she came right away when she fell.
1 client said C1 leaves alot. Another client said that 3 staff were helping her and they responded quickly.
Staff interviewed stated that C 1 will leave to the mall, stores and church independently.
Initial Program Plan (IPP) meeting 6/23/20 states that Client 1 can independently purchase a plane ticket and travel via airplane.
Under Reasonable Progress Social Recreational it states that C 1 attends church independently, is reliant on Public Transportation and Access services and spends most of her time in the community.
Most updated routine doctor's visit to primary physician for C 1 on 8/17/21 noted that C 1 can go out independently for 3 hours.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation Resident is mistreated by staff, based on interviews conducted and information gathered C 1 stated that staff is nice to her.
1 Client stated that they treat good at the facility like family.
Said C 1 needs attention. Said they treat C 1 good.
Stated that they speak to her and don't abuse her on nothing. Said she just needs attention.
Stated they take good care of C 1.
Another client stated that people here are treated nice.
Staff speak to C 1 kindly and they treat C 1 nice.
Hasn't seen any situations in which they treated C1 unkindly.
Staff interviewed stated C 1 needs attention and is not mistreated.
Said that C 1 is treated kindly and staff said they are sweet to Client 1.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.




NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2