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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604696
Report Date: 02/11/2025
Date Signed: 02/11/2025 06:55:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2025 and conducted by Evaluator Carmen Lopez
COMPLAINT CONTROL NUMBER: 08-AS-20250211083051
FACILITY NAME:SIERRA SUNSHINE CAREFACILITY NUMBER:
374604696
ADMINISTRATOR:CHAPARI, CINDYFACILITY TYPE:
740
ADDRESS:1355 HACIENDA DR.TELEPHONE:
(657) 259-8146
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 4DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Licensee Shawn Chapari, and Administrator Cindy ChapariTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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- Medications are not being administered as prescribed
- Hot water is not regulated within the allotted temperatures
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered two findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Pouya “Paul” Ghorbanpour, caregiver. LPA stated the purpose of the visit and reviewed the basic elements of the visit with caregiver Ghorbanpour. The findings of the complaint were delivered to licensee Shawn Chapari and administrator Cindy Chapari.

The Department’s investigation consisted of interviews with staff and residents, and LPA observations of the facility grounds. On February 10, 2025, it was said that the medications are not being administered as prescribed and hot water is not regulated within the allotted temperatures.

It was specifically said that the residents’ medications were not in their original containers. On January 29, 2025, during an unrelated visit, LPA observed that medications were being dispensed via pill box. LPA spoke with both the licensee Chapari and administrator Chapari regarding medications being dispensed from their original container. Both agreed to dispense their medications by their proper container.

(Continuation on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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 4
Control Number 08-AS-20250211083051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SIERRA SUNSHINE CARE
FACILITY NUMBER: 374604696
VISIT DATE: 02/11/2025
NARRATIVE
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(Continuation of LIC9099)

On February 11, 2025, LPA toured the facility and requested to observe their medication cabinet. Upon the review of their medications, LPA observed that the facility dispensed their medications for the entire week in their respective pill box. Upon staff interviews, both staff #1 (S1) and staff #2 (S2) confirmed that they use the pillboxes to dispense medications. According to S1, they were directed to continue to place the medications in the pill box by their administrator on January 30, 2025. Based on the information obtained, there is sufficient evidence to meet the preponderance of evidence standard.

It was said that the hot water temperatures are too high. During the tour of the facility, LPA was able to measure the hot water temperatures of the three bathrooms and the kitchen. The hot water temperatures read as follows: bathroom #1 measured hot water temperature at 120.7 degrees Fahrenheit; bathroom #2 measured hot water temperature at 119.7 degrees Fahrenheit; bathroom #3 measured hot water temperature at 121.3 degrees Fahrenheit; and kitchen sink measured hot water at 121.3 degrees Fahrenheit. The kitchen sink did have a sign on the faucet that read “water very hot.” Based on the evidence obtained, there is sufficient evidence to meet the preponderance of evidence standard.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and resident interviews, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D page of this report.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with licensee Shawn Chapari and administrator Cindy Chapari. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Chapari at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250211083051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SIERRA SUNSHINE CARE
FACILITY NUMBER: 374604696
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
CCR
87465(h)(5)
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Incidental Medical and Dental Care (h)(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers...This requirement was not met as evidence by:
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Administrator will be placing the residents medications back to their original containers and removing the pill boxes and inform LPA by POC due date, 02/21/2025.
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Based on LPA observations, facility did not store residents medication in its original container. This posed a potential health risk to 3 of 4 residents in care.
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Type B
02/26/2025
Section Cited
CCR
87303(e)(2)
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(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met as evidence by:
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Licensee will be lowering the hot water temperature and maintain a log for 2 weeks and submit the logs to LPA by POC due date, 02/26/2025.
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Based on LPA observations, facility did not ensure that hot water at taps were within the allotted measures. This posed a potential health risk to 3 of 4 residents 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: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4