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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004407
Report Date: 03/22/2023
Date Signed: 03/22/2023 03:00:55 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, 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
03/13/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230313154427
FACILITY NAME:ROSSMOOR SUNSHINE VILLA-FOSTERFACILITY NUMBER:
306004407
ADMINISTRATOR:RICARDO BANOSFACILITY TYPE:
740
ADDRESS:12521 FOSTER ROADTELEPHONE:
(562) 572-9931
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:6CENSUS: 6DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Flormine ResurreccionTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled client in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an announced 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator Flormine Resurreccion and explained the reason for the visit. The investigation into the allegation, staff handled resident in a rough manner revealed the following. It was alleged that staff handle residents in a rough manner when providing care or assisting residents. 4 out of 6 residents and 2 out of 2 witnesses interviewed could not corroborate that report. 4 out of 4 staff interviewed denied the allegation. There have been no reports of any type of abuse or mishandling of residents. Based on the evidence gathered the allegation, staff handled resident in a rough manner is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/13/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230313154427

FACILITY NAME:ROSSMOOR SUNSHINE VILLA-FOSTERFACILITY NUMBER:
306004407
ADMINISTRATOR:RICARDO BANOSFACILITY TYPE:
740
ADDRESS:12521 FOSTER ROADTELEPHONE:
(562) 572-9931
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:6CENSUS: 6DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Flormine ResurreccionTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not administering resident's medication as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an announced 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Flormine Resurreccion and explained the reason for the visit. The investigation into the allegation, staff are not administering resident's medication as prescribed revealed the following. LPA reviewed 6 out of 6 resident's medication and medication records for March 2023. No discrepancies were observed. 4 out of 6 residents interviewed and 4 out of 4 staff interviewed could not corroborate the report. Based on the evidence gathered the allegation, staff are not administering medication as prescribed is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2