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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366408218
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:09:48 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
10/11/2024 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20241011163624
FACILITY NAME:SUNSHINE HOME IIFACILITY NUMBER:
366408218
ADMINISTRATOR:ALBAO, LOURDESFACILITY TYPE:
740
ADDRESS:2158 SYCAMORE AVENUETELEPHONE:
(909) 874-8114
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY:6CENSUS: 3DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Rosario Nicolas, AdministratorTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff neglect of resident(s)
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to commence a complaint investigation. LPA was greeted and granted entrance by staff, Tessie Martinez. LPA identified herself and discussed the purpose of the visit. LPA ask that (S1) called and informed the administrator, Rosario Nicolas about the purpose of the visit. During today’s visit, LPA interviewed staff and clients, requested and collected documents.

It is alleged that staff neglect of resident(s). Interview with client one (C1) stated that staff treats C1 good and the food is good here. C1 stated that staff (S1) cooks all the time and cleans the facility. C1 stated that staff were informed that C1 can't eat white rice and staff did provide substitute starch for C1. C1 stated she likes living here and her only concern was her roommate talks too much and she can't sleep. C1 stated that sometime she leaves the room and go watch TV in the family room until her roommate goes to sleep. C1 stated that the concern is having a seizure and going to the hospital. Two (2) of the three (3) clients were not in the home and were at the day program. Interview with S1 stated that S1 treats all clients with respect and care. S1 stated that all clients are provided plenty of food and clothing, and she never seen any clients neglected.

During the tour of the facility LPA observed the facility has plenty of perishable and non-perishable item in the home for residents in care. Also, the facility has sufficient cleaning, and hygiene items for residents in care.

Based on the information above, the allegation is 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. An exit interview was conducted where this report LIC 9099 and LIC 9099C was discussed, and a copy was provided to Administrator Rosario Nicolas.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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 56-AS-20241011163624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE HOME II
FACILITY NUMBER: 366408218
VISIT DATE: 10/16/2024
NARRATIVE
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Based on the information above, the allegation is 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. An exit interview was conducted where this report LIC 9099 and LIC 9099C was discussed, and a copy was provided to Administrator Rosario Nicolas.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2