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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601725
Report Date: 08/01/2024
Date Signed: 08/02/2024 09:20:26 AM

Document Has Been Signed on 08/02/2024 09:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:A SUNNYDAY GUEST HOMEFACILITY NUMBER:
198601725
ADMINISTRATOR/
DIRECTOR:		LORNA B. CASTROFACILITY TYPE:
740
ADDRESS:411 W. 226TH STREETTELEPHONE:
(424) 731-7451
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 6CENSUS: DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:33 PM
MET WITH:Lorna ZablockiTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 08/01/2024, Licensing Program Analysts (LPAs) Zina Brown & Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with administrator Lorna Zablocki. LPAs explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory residents ages 60 and above. Currently, the facility has (0) hospice resident in care. The facility is approved for (3) hospice residents.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: (3) residents' rooms, (2) bathrooms, (1) staff bedroom, a living area, a dining area, a kitchen, an outside seating area.

LPAs toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 105.5 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility.

LPAs observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Two fire extinguishers were fully charged. A review of the Medication Records Administration (MAR) was observed to be maintained in order and complete.

(Evaluation Report continues LIC 809-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: A SUNNYDAY GUEST HOME
FACILITY NUMBER: 198601725
VISIT DATE: 08/01/2024
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During the visit, LPAs observed the facility's infection control practices. LPAs observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAs observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has in stock Emergency Food Supplies.

LPAs observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 07/08/2024. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 07/01/2024 through 07/01/2025. The facility is current on CCL license annual dues.

An audit of resident #1-#4 (R1-R4) service files and staff #1-#5 (S1-S5) personnel files revealed to be complete. The facility has the current administrator's certification on file for Charlene Castro Espiritu #7010536740 Expiration: 06/26/2026.

No deficiencies during this inspection visit.

An exit interview was conducted with Lorna Zablocki and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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