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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405802278
Report Date: 08/15/2025
Date Signed: 08/15/2025 11:54:46 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2025 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20250809093436
FACILITY NAME:SUNRISE TERRACE RCFE VFACILITY NUMBER:
405802278
ADMINISTRATOR:GREGORIO, ALBERTFACILITY TYPE:
740
ADDRESS:2117 DEL NORTETELEPHONE:
(805) 534-0808
CITY:LOS OSOSSTATE: CAZIP CODE:
93402
CAPACITY:6CENSUS: 6DATE:
08/15/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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The facility is not kept clean, sanitary or in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Edwin Ingan, Administrator and explained the purpose of the visit.

LPA requested a staff roster, a resident roster, and staff schedule for August 2025. LPA took a tour of the inside of the facility. LPA took photographs. The following was noted:

On the allegation: The facility is not kept clean, sanitary or in good repair. LPA took photographs of the hallway and bathroom areas in the facility. A witness reported that on 08/05/2025 the hallway and bathroom were dirty and in need of repair and new paint. The witness had already reported the need to the Administrator of the facility about 3 weeks prior and nothing had been taken care of. LPA observed the hallway and the bathroom to be painted but over scratched areas made by wheelchairs with paint, the paint does not match the prior paint color leaving it to look dingy throughout the facility. Cont. 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
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 3
Control Number 29-AS-20250809093436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE TERRACE RCFE V
FACILITY NUMBER: 405802278
VISIT DATE: 08/15/2025
NARRATIVE
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The bathroom looks clean and sanitary and in good repair other than needing new paint on the far wall. LPA spoke with the Administrator which revealed the facility needs painting, they have called a painter to come out to give us an estimate, and the facility will be painted soon. The facility had staff 1 (S1) go around with paint and painted the scratched areas. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250809093436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE TERRACE RCFE V
FACILITY NUMBER: 405802278
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
87303(a)
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(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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The administrator agreed to paint the facility hallways, bathrooms and any areas that need to be painted, to keep the facility in good repair. Review regulation 87303 and make sure the facility is following the full regulation. Provide pictures of the facility hallways, bathrooms, and walls once painted to CCL.
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Based on witness and LPA observation, the licensee did not comply with the regulation above the facility hallway and bathroom were not kept in good repair and in need of painting which poses a potential health, safety and personal rights risk to 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: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3