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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880681
Report Date: 06/12/2023
Date Signed: 06/12/2023 01:22:57 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220714134111
FACILITY NAME:SUNSHINE BOARD & CAREFACILITY NUMBER:
361880681
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
740
ADDRESS:720 N LINDEN AVETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:12CENSUS: 12DATE:
06/12/2023
UNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Ahmad Abdallatef TIME COMPLETED:
01:24 PM
ALLEGATION(S):
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Facility did not give resident’s representative the right to participate in decision-making regarding the care and services to be provided to the resident (R1).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to deliver findings on the above complaint allegations. LPA met with staff Manal Terab. Terab phoned licensee Najeh Hamed was notified of the reason for today’s . Co-administrator Ahmad Abdallatef arrived shortly. The investigation included interviews with witness and staff and records review.

The allegation is that the facility did not give resident’s representative the right to participate in decision-making regarding the care and services to be provided to the resident (R1). Witness interview confirmed that R1 is self-responsible for decisions related to their care however R1 has a court-ordered fiduciary. The interview further revealed that the fiduciary is solely responsible for R1 finances and does not need to be consulted for any services that R1 wishes to use or add. Staff interviews revealed that R1 is a former resident who needed a higher level of care and was transferred to a hospital and has not returned to the facility since. This allegation is therefore unsubstantiated.

A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. A copy of this report was reviewed and provided to Ahmad Abdallatef.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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 4
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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2022 and conducted by Evaluator Anna Bueno
COMPLAINT CONTROL NUMBER: 56-AS-20220714134111

FACILITY NAME:SUNSHINE BOARD & CAREFACILITY NUMBER:
361880681
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
740
ADDRESS:720 N LINDEN AVETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:12CENSUS: 12DATE:
06/12/2023
UNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Ahmad AbdallatefTIME COMPLETED:
01:24 PM
ALLEGATION(S):
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Resident is being financially abused.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to deliver findings on the above complaint allegations. LPA met with staff Manal Terab. Terab phoned licensee Najeh Hamed was notified of the reason for today’s visit. Co-administrator Ahmad Abdallatef arrived shortly. The investigation included interviews with witness and staff and records review.

The allegation is that Resident (R1) is being financially abused. Staff interviews stated that the R1 was a former resident who needed a higher level of care and transferred out of the facility. Witness interviews confirm that R1 has been residing at a skilled nursing facility since March 2021. Records reviewed show that the current licensee received their license in 2020. Records further show that automatic monthly payments to the facility continued after March 2021 through July 2022. This allegation is therefore substantiated.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential health and safety risk to residents in care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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 4
Control Number 56-AS-20220714134111
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
, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 06/12/2023
NARRATIVE
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Refer to LIC809-D for deficiency cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided Ahmad Abdallatef.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20220714134111
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
, CA 92507

FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2023
Section Cited
CCR
87507(g)(5)(C)(2)
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(g) Admission agreements shall specify the following: (5) Refund conditions. (C) The licensee shall refund any prepaid monthly fees to a resident or the resident’s representative, if any, as follows: (2) If there is a change of use of the facility pursuant to Section 87224(a)(5).
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Licensee shall refund the monthly payments to R1 and their authorized representative from March 2021 through July 2022. Licensee shall provide proof of correction no later than end of day of POC date.
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This requirement was not met as evidenced by:

Records reviewed show that R1 monthly payment continued from March 2021 through July 2022. Staff and witness interviews confirm that R1 has moved out of the facilty in March 2021.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4