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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405802274
Report Date: 09/02/2026
Date Signed: 09/02/2026 03:45:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/30/2026 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20260730114026
FACILITY NAME:SUNRISE TERRACE RCFE IFACILITY NUMBER:
405802274
ADMINISTRATOR:INGAN, EDWINFACILITY TYPE:
740
ADDRESS:1135 OCEANAIRE DRIVETELEPHONE:
(805) 544-0982
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:6CENSUS: 6DATE:
09/02/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator - Edwin InganTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff mismanage residents medications
INVESTIGATION FINDINGS:
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On 9/2/2026 at 9:30am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the above allegation to this complaint. LPA met with Administrator Edwin Ingan and explained the purpose of the visit.

During a visit conducted on 7/30/2026 and today’s visit LPA checked the wellbeing of the residents in care and conducted interviews. LPA also conducted the facility annual inspection during today’s visit.

On the allegation, staff mismanage residents medications; it was alleged that on a day in August 2026 Resident #1 (R1) was observed in bed with two medication cups left within arm’s reach of them on their bedside table. One cup had two pills in it and the other had one pill in it. It was also alleged that R1 stated the medication in the cup with one pill was an as needed (PRN) medication and R1 had not requested it.

(Conitnued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
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 5
Control Number 29-AS-20260730114026
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE TERRACE RCFE I
FACILITY NUMBER: 405802274
VISIT DATE: 09/02/2026
NARRATIVE
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Review of R1’s medical assessment dated 12/26/2025 states that they are not able to manage their own medications and are at risk if given access to hazardous items. LPA observation and staff interviews reveal R1 shares a room with another resident.

Staff stated R1 insists on having their medication placed on their bedside table so they can take it when they want to. Interviews and record review reveal that the two pills in the one cup left for R1 are carbidopa-levodopa scheduled at 12:00pm. According to available resources, the effectiveness of carbidopa-levodopa depends on the medication being taken at consistent times each day to ensure stable levels in the body and maintain steady symptom control. Staff stated the cup containing one pill was a lorazepam 0.5mg tablet. Record review reveals R1 is prescribed the lorazepam twice daily and PRN. Staff state the dose left on the table was scheduled for 8:00am but R1 likes to determine when they want to take it. During a visit conducted on 8/11/2026 LPA observed R1 to have a bottle of Tums left on their bedside table.

Based on all interviews conducted and documents obtained, at this time the above allegation was found to be substantiated, the facility left centrally stored medication unlocked for R1 who is not able to manage their own medications and the medications were accessible to other residents in care, there is a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted, deficiencies cited on LIC9909-D page, report signed, appeal rights and report provided to the Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20260730114026
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUNRISE TERRACE RCFE I
FACILITY NUMBER: 405802274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/03/2026
Section Cited
CCR
87465(h)(2)
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(h) ...(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by:
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Administrator states they have not been leaving medications and will schedule training for staff who manage medications on the importance of locking medications leaving them unattended, residents taking their medication timely and other residents having access to the medications.
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Based on observation, interviews and record review, the Licensee did not comply with the section cited above when they left medication accessible to residents which poses an immediate health and safety risk to residents in care.
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They will email LPA training documents and signed roster on or before 9/16/2026.
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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.
SUPERVISOR'S NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/30/2026 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20260730114026

FACILITY NAME:SUNRISE TERRACE RCFE IFACILITY NUMBER:
405802274
ADMINISTRATOR:INGAN, EDWINFACILITY TYPE:
740
ADDRESS:1135 OCEANAIRE DRIVETELEPHONE:
(805) 544-0982
CITY:SAN LUIS OBISPOSTATE:CAZIP CODE:
93405
CAPACITY:6CENSUS: 6DATE:
09/02/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator - Edwin InganTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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3
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9
Staff do not ensure residents receive safe, healthful accommodations.
INVESTIGATION FINDINGS:
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On 9/2/2026 at 9:30am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the above allegation to this complaint. LPA met with Administrator Edwin Ingan and explained the purpose of the visit.

During a visit conducted on 7/30/2026 and today’s visit LPA checked the wellbeing of the residents in care and conducted interviews. LPA also conducted the facility annual inspection during today’s visit.

On the allegation, staff do not ensure residents receive safe, healthful accommodations; it was alleged that in the shared bathroom in the hallway there was a bar of soap used by multiple residents and two residents were in the living room, neither had any liquid to drink within reach.

(Conintued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20260730114026
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE TERRACE RCFE I
FACILITY NUMBER: 405802274
VISIT DATE: 09/02/2026
NARRATIVE
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Regarding the use of communal soap staff interviews revealed that the bar of soap was purchased by one of the care staff for Resident #2 (R2) and used it to provide R2 bed baths. The Administrator states they typically purchase liquid soap because they think using communal bar soap is not hygienic. California Code of Regulations, Title 22, Division 6, Chapter 8 requires facilities to provide hygiene items of general use such as soap but does not specify whether the soap must be liquid, bar, or any particular form.

Regarding residents not having liquids to drink within arm’s reach. During visits conducted on 7/30/2026, 8/11/2026, and today’s visit LPA observed each resident to have a liquid drink within reach. LPA also observed the facility had multiple drink options including water, a variety of juices, coffee, tea, and soda. Residents who are able to communicate, stated that staff bring them something to drink with each meal and if they need more, they can call staff for assistance. Staff stated that they feel they are good about providing residents with something to drink throughout the day especially those that cannot communicate. They said that they cannot force the residents to drink but they encourage them to drink liquids throughout the day.

Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted, report signed, and report provided to the Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5