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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002108
Report Date: 09/21/2023
Date Signed: 09/21/2023 11:54:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2020 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200904102606
FACILITY NAME:SUNNY RIDGE MANOR HOMEFACILITY NUMBER:
306002108
ADMINISTRATOR:RUDY & FEMY SALVADORFACILITY TYPE:
740
ADDRESS:1201 POST ROADTELEPHONE:
(714) 526-7983
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:6CENSUS: 6DATE:
09/21/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Femy Salvador, AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff verbally and physically abused resident
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to follow up on the investigation of the allegation listed above. LPA was greeted and granted entry after introducing himself and stating the purpose of the visit. Administrator Femy Salvador was notified of the visit by telephone and arrived shortly afterwards to assist.

An initial complaint investigation visit was conducted virtually by LPA Lydia Martinez on September 8, 2020 due to COVID-related restrictions in place at the time. Additional resident records were provided via email in the days following the visit.

LPA requested and reviewed staff files as well as resident files for all six residents present at the time of this visit. All residents now admitted have been admitted in 2021 or later.

CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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 22-AS-20200904102606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUNNY RIDGE MANOR HOME
FACILITY NUMBER: 306002108
VISIT DATE: 09/21/2023
NARRATIVE
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CONTINUED FROM LIC9099-C
LPA accompanied by administrator conducted a tour of the facility's physical plant. All six residents are observed either relaxing in the facility's common areas or in their respective bedrooms. Three residents are observed receiving visits, one from a hospice nurse and another two from their relatives/responsible parties.

LPA attempted or conducted interviews with all six residents in addition to administrator and three caregivers present during the visit. Additional witness interviews conducted on September 20, 2023 via telephone.

Regarding the allegation that Staff verbally and physically abused resident, the following has been concluded: Based on records reviewed and interviews conducted, no evidence gathered is corroborating the allegation. However, due to investigation delays, most of the interviews conducted involved individuals not present at the facility at the time the allegation was made. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of the report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2