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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609684
Report Date: 08/28/2025
Date Signed: 08/28/2025 01:06:32 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2025 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20250823170952
FACILITY NAME:SUNNYBRAE HOMEFACILITY NUMBER:
197609684
ADMINISTRATOR:SAVELLA, JEFFREYFACILITY TYPE:
740
ADDRESS:8001 SUNNYBRAE AVETELEPHONE:
(323) 455-7821
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 4DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Josephine Espiritu - Direct Care StaffTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Licensee admitted resident without conservator's approval.
Staff did not seek medical attention for resident in a timely manner.
Staff did not assist resident with care needs in a timely manner.
INVESTIGATION FINDINGS:
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On 8/28/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an initial 10-day complaint visit to investigate the above allegations. Upon arrival, LPA met with the staff Josephine Espiritu, introduced herself by showing department badge and explained the reason for the visit. The Administrator was contacted over the phone and arrived shortly after. LPA disclosed the reason for the visit. Entrance interview conducted.

At 11:00am, LPA requested and reviewed residents and staff rosters. At approximately 11:05am, LPA conducted a physical plant tour to ensure health and safety of the residents are protected. During the tour of the facility. LPA did not observe Resident #1 (R1) residing in the facility. Between 11:25am – 12:30pm, LPA conducted interviews with the Administrator, two (2) staff/caregivers, and two (2) out of four (4) residents residing at the facility who were able to communicate.
Continue on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 3
Control Number 31-AS-20250823170952
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNNYBRAE HOME
FACILITY NUMBER: 197609684
VISIT DATE: 08/28/2025
NARRATIVE
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Allegation: Licensee admitted resident without conservator's approval.

It was reported by RP that Resident #1 (R1) was placed onto this board and care without approval of conservator. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. The Administrator also stated that to admit a new resident, they follow and practice all the required Title 22 Regulations. Interviews with two (2) out of four (4) residents who were able to communicate, also confirmed they had never seen or heard of R1 living in the facility. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint.

Allegation: Staff did not seek medical attention for resident in a timely manner.

It was reported by RP that Resident #1 (R1) was discovered unresponsive, unable to open eyes, and appeared to be suffering from infection and dehydration. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. Interviews with two (2) out of four (4) residents who were able to communicate also confirmed they had never seen or heard of R1 living in the facility. Residents stated they receive excellent care and supervision residing in this facility and never had any issues with staff members not providing medical attention on a timely manner. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250823170952
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNNYBRAE HOME
FACILITY NUMBER: 197609684
VISIT DATE: 08/28/2025
NARRATIVE
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Allegation: Staff did not assist resident with care needs in a timely manner.

It was reported by RP that Resident #1 (R1) was discovered unresponsive, unable to open eyes, and appeared to be suffering from infection and dehydration. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. Interviews with two (2) out of four (4) residents who were able to communicate also confirmed they had never seen or heard of R1 living in the facility. Residents stated they receive excellent care and supervision residing in this facility and never had any issues with staff members not providing care needs on a timely manner. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint.

Exit interview conducted.

Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3