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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004049
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:38:54 PM

Unfounded


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
08/29/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240829103548
FACILITY NAME:ROSSMOOR SUNSHINE VILLA-WEMBLEYFACILITY NUMBER:
306004049
ADMINISTRATOR:ROBERT DALE KALAGAYANFACILITY TYPE:
740
ADDRESS:11322 WEMBLEY ROADTELEPHONE:
(562) 493-3987
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:6CENSUS: 5DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jesus Gueco-CaregiverTIME COMPLETED:
03:54 PM
ALLEGATION(S):
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Staff yells at or belittles resident
Facility did not arrange for medical care appropriate to resident needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Jesus Gueco. LPA explained the reason for the visit.

This agency has investigated the complaint alleging that staff yells at or belittles resident and facility did not arrange for medical care appropriate to resident needs. Regarding the allegations, the following was revealed: Two of two individuals interviewed denied the allegations. LPA reviewed documents including the Report of Suspected Dependent Adult/Elder Abuse (SOC341) dated August 28, 2024 for Resident 1 (R1). Per Report of Suspected Dependent Adult/Elder Abuse R1 lives at Rossmoor Sunshine Villa located at 11322 Wembley Road Los Alamitos, CA 90720.


CONTINUED ON LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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-20240829103548
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: ROSSMOOR SUNSHINE VILLA-WEMBLEY
FACILITY NUMBER: 306004049
VISIT DATE: 09/05/2024
NARRATIVE
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During the initial visit on September 05, 2024 LPA reviewed documents including the Register of Facility Clients/Residents dated September 05, 2024. Per Register of Facility Clients/Residents R1 is not a resident at Rossmoor Sunshine Villa-Wembley. During the course of the interviews with staff, Staff 1 (S1) reported that R1 has never been a resident at this facility.

Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis.

LPA Ramirez conducted an exit interview with caregiver Gueco, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2