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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801682
Report Date: 02/01/2023
Date Signed: 02/01/2023 11:19:51 AM

Unfounded


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
01/30/2023 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20230130093413
FACILITY NAME:SUNSHINE HEALTH PLACEFACILITY NUMBER:
565801682
ADMINISTRATOR:SLIM MARONFACILITY TYPE:
740
ADDRESS:1558 NORMAN AVENUETELEPHONE:
(805) 446-3100
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 6DATE:
02/01/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cilva ToumeTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained injuries while in care.
Staff refused to accept resident back to the facility after a hospital visit.
Staff are not responding to requests for communication about resident in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Administrator Cilva Toume and explained the reason for the visit. To investigate, the LPA interviewed staff on 01/30/2023 at 1:44 p.m. and 1:55 p.m. The LPA spoke with a family member of Resident #1 (R1) on 01/30/2023 at 1:07 p.m. and on 1/31/2023 at 3:12 p.m. The LPA also interviewed a staff person at a collateral facility at 1/31/2023 at 1:25 p.m. and, the LPA obtained relevant records.

The allegations above pertain to Resident #1 (R1). The investigation revealed that R1 did not reside at this facility and resided at a congregate living facility, which is licensed by the California Department of Public Health. Per the investigation, the allegations are deemed Unfounded at this time. A finding of Unfounded means that the allegations are either false, could not have happened, and/or is without a reasonable basis.

No deficiencies cited at this time. Exit interview. A copy of the report was issued.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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