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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880681
Report Date: 07/25/2023
Date Signed: 07/25/2023 10:09:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/26/2023 and conducted by Evaluator Amber Coleman
COMPLAINT CONTROL NUMBER: 56-AS-20230426145407
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: 9DATE:
07/25/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Najeh Hamed & Yusef Nofal, AdministratorsTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff neglect led to hospitalization of a resident.
Staff member mismanages medication.
Staff failed to provide adequate food service.
Facility is unsanitary.
Insufficient staffing to meet residents' needs
Staff failed to provide a comfortable environment for residents in care.
Staff member sleeps while on duty.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board and Care Facility to deliver findings of the complaint investigation. LPA introduced self and stated purpose of the visit. LPA spoke with Staff Member, Tyrone; who contacted Administrators to notify of LPA's visit. LPA met with Administrators and discussed the complaint findings.

Staff neglect led to hospitalization of resident.
It is alleged that the facility staff neglect led to the hospitalization of the resident. Resident interviews reflect that a resident was in need of assistance one evening, he could not get the attention of the night staff member scheduled that evening. He contacted 911 and was able to get assistance. Staff interviews reveal that staff members deny staff sleeps on the job or that a resident called for assistance and was unable to get assistance. Record reviews reflect that the resident went to the hospital for treatment, but nothing suggests that the resident was sent to the hospital because of neglect or lack of supervision. At this time, there are no Special Incident Reports in the Community Care Licensing Duty Logs... Please see LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/26/2023 and conducted by Evaluator Amber Coleman
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230426145407

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: 9DATE:
07/25/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrators Yusef Nofal & Najeh HamedTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Untrained staff.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board and Care Facility to deliver findings of the complaint investigation. LPA introduced self and stated purpose of the visit. LPA spoke with Staff Member, Tyrone; who contacted Administrators to notify of LPA's visit. LPA met with Administrators and discussed the complaint findings.

It is alleged that the facility employs untrained staff to care for the residents. Staff denied that their staff are not properly trained. LPA reviewed eight (8) personnel files. Out of 8 personnel files, two (2) personnel files contained medication training. Orientation pages for personnel were left blank or incomplete, while others were missing altogether. Staff records were missing for one employee. Personnel files also revealed an expired Administrator Certificate for Najeh Hamed. 1 out of 8 files was missing proof of medication training. Upon LPA’s entry to the building, LPA met with a staff member. While sharing the purpose of the visit, staff reported to not speak a lot of English, and it would be best that LPA speak to the Administrator to obtain information. This is a staff member who resides on facility grounds and who provides most of the care to the residents during most day shifts.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 56-AS-20230426145407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 07/25/2023
NARRATIVE
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Based on interviews and observations, we have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 56-AS-20230426145407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2023
Section Cited
HSC
1569.69(3)
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Employees assisting residents with self-administration of medication; training requirements An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications.
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Administrator agrees to have all staff who assist residents with self administration of medications be properly and adequately trained with in the next 24 hours. Administrator also agrees to submit a statement of understanding by way of LIC9098 that the regulation is understood.
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This requirement is not met as evidenced by:
Based on observation and file review, Administrator did not ensure that all staff who handle medications for the residents in care were adequately trained to do so. This poses an immediate Health, Safety or Personal Rights risk to persons in care.
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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: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 56-AS-20230426145407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 07/25/2023
NARRATIVE
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reporting that a resident in care was sent to the hospital. Based on interviews and record reviews, we have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred.

Staff member mismanages resident medications.
It is alleged that staff mismanage resident medications. All staff deny that the resident’s medications are mismanaged. Resident interviews do not reflect residents in care have had a problems with their medications. LPA requested the Medication Administration Records, (MARS) for review. LPA reviewed the MARS for the residents in care and found the record did not display anything unusual.

Staff failed to provide adequate food services. Resident interviews reflect that residents don’t have an issue with the food that is being served during meal time. Residents in care shared that there is always an ample amount of food. Resident can ask for seconds and if what is being cooked isn’t preferred there are alternatives offered. LPA walked through the kitchen for observation. LPA observed an operational refrigerator which included fresh fruits and vegetables, milk and juices in the amount appropriate for the number of residents in care. LPA observed the two pantries which revealed a number of canned goods with in good standing. Deep freezers held frozen meals, treats and meats appropriate for the number of residents in care. LPA was also present while lunch was being served and observed a clean cooking station and food being prepared and served according to regulation. Staff provided LPA with the monthly food menu to include a variety nutritional meals.

It is alleged that the facility is unsanitary. During the visit, LPA observed the facility’s physical plant. LPA observed no obstructions of the pathways. The hallway did appear to be dark, but there are several light switches along the wall which adequately lights up the pathway. LPA observed the smell and fumes of cleaning products throughout the facility. Resident rooms contained all regulated furniture. Each room appeared clean and orderly. The kitchen area also appeared clean and orderly. Outside of the facility no obstructions observed. A patio included a shady area and adequate seating. Resident interviews revealed that staff cleans the facility frequently because they can smell the presence chemicals in use. During staff interviews, it was discovered that the facility is cleaned up to three times a day. In the mornings during Breakfast Administrators work on cleaning the resident rooms. This includes dumping trash cans, sweeping, removing clutter, making beds and cleaning the bathrooms.
Please see LIC9099C
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 56-AS-20230426145407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 07/25/2023
NARRATIVE
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It is alleged that the facility is unsanitary. During the visit, LPA observed the facility’s physical plant. LPA observed no obstructions of the pathways. The hallway did appear to be dark, but there are several light switches along the wall which adequately lights up the pathway. LPA observed the smell and fumes of cleaning products throughout the facility. Resident rooms contained all regulated furniture. Each room appeared clean and orderly. The kitchen area also appeared clean and orderly. Outside of the facility no obstructions observed. A patio included a shady area and adequate seating. Resident interviews revealed that staff cleans the facility frequently because they can smell the presence chemicals in use. During staff interviews, it was discovered that the facility is cleaned up to three times a day. In the mornings during Breakfast Administrators work on cleaning the resident rooms. This includes dumping trash cans, sweeping, removing clutter, making beds and cleaning the bathrooms.

Insufficient staffing to meet resident needs. LPA was provided with the facility staff schedule which reflected that two staff members are present 7am to 6pm. One being an Administrator and the other a direct care staff member. The evenings 6pm to 7am are covered by another staff member. Staff interviews are consistent with the staff schedule. Resident interviews reflect that residents are able to get assistance in a timely manner. During LPA visit, LPA observed both Administrators present and two staff members.

It is alleged that staff failed to provide a comfortable environment for the residents in care. During the visit, LPA observed that the facility appeared to be clean and orderly, free of obstructions. LPA observed the same of the residents’ rooms and hallways. LPA observed the temperature of the facility to be cool and comfortable. Resident’s rooms also appeared to be clean and orderly. Resident interviews did not support the allegation that the facility is not comfortable. Residents report feeling safe inside the facility. Staff interviews were consistent with resident interviews. Staff denied that a resident complained of the facility being uncomfortable or unsafe.

It is alleged that a staff member sleeps while on duty. Staff reported that one staff member works during the evenings. According to Administrators, there have been no reports of the staff member sleeping during the shift. Staff also denied that they had ever went to sleep while on duty of the facility. Because the staff member who normally works in the evenings was not present during the visit, LPA is unable to interview her. One (1) Resident interview revealed that the staff member who works during the evenings does sleep during the shift. As he called out, and the staff member did not respond. This resulted in the resident having to call 911 himself. Due to conflicting statements and the inability to interview the staff member in question.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 56-AS-20230426145407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 07/25/2023
NARRATIVE
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We have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7