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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 02/19/2025
Date Signed: 02/19/2025 02:49:13 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/01/2024 and conducted by Evaluator Yolanda Delgado
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240201095941
FACILITY NAME:SUN CITY GARDENSFACILITY NUMBER:
331881358
ADMINISTRATOR:DIANE DOMINGOFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 62DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Joey Collado, Executive Director & Barbara Guzman, Business Office ManagerTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff did not timely replace a light bulb in a resident's room
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Yolanda Delgado arrived unannounced to the facility to conclude an investigation pertaining to the allegation listed above. LPA met with Executive Director Joey Collado and Business Office Manager Barbara Guzman and explained the purpose of the visit.

On February 1, 2024, Community Care Licensing received a complaint alleging staff did not replace a light bulb in Resident #1’s bedroom due to an outage and that R1 could not see to get to the restroom. LPA conducted an interview with Administrator which revealed that when services request is presented, maintenance fixes as soon as possible. Administrator also stated that there was no request for a light bulb replacement. Information obtained from interviews with maintenance and housekeeping staff revealed that resident’s room has two lamps with working lightbulbs and the hallway light illuminates the pathway leading to the resident’s restroom from the bathroom. LPA conducted an Interview with an additional witness and advised that a family member replaced the lightbulb.
(Continued on Page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 2
Control Number 18-AS-20240201095941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUN CITY GARDENS
FACILITY NUMBER: 331881358
VISIT DATE: 02/19/2025
NARRATIVE
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(Continued from Page 1)

It was not advised if Resident #1 notified staff that a replacement was needed. LPA attempted to interview R#1, but due to R1’s cognitive ability, LPA was unable to verify resident was a reliable historian of record.

During a visit to the facility, LPA observed a bedside lamp that was unplugged. The lamp was plugged in and had a working light bulb. LPA checked the other light sources, and they were all in working condition. LPA conducted a review of service requests and there were no requests to replace a light bulb in the resident’s room. Documentation did state that Resident #1 will often unplug their personal lamp and housekeeping will plug the lamp back in.

Based on interviews and facility records, the allegation that staff did not replace a light bulb in a resident’s room is Unsubstantiated. Although the allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Joey Collado, ED and a copy of this report along with LIC811- Confidential Names list was provided.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2