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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002108
Report Date: 03/03/2022
Date Signed: 03/03/2022 09:59:17 AM

Document Has Been Signed on 03/03/2022 09:59 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNNY RIDGE MANOR HOMEFACILITY NUMBER:
306002108
ADMINISTRATOR:RUDY & FEMY SALVADORFACILITY TYPE:
740
ADDRESS:1201 POST ROADTELEPHONE:
(714) 526-7983
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 6DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Femy SalvadorTIME COMPLETED:
10:11 AM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and granted entry. LPA met with Administrator Femy Salvador. LPA explained the reason for the visit. LPA and Administrator toured the facility. The facility has 5 bedrooms, 2 bathrooms, living room, dining room, kitchen, laundry room and a two car attached garage. LPA and Administrator toured the facility. LPA observed PUB 475 (See Something, Say Something poster) was 8 1/2 by 11 inches. LPA observed the fireplace is screened. LPA observed all of the resident bedrooms (4 resident rooms, 1 room is for staff) had the required furnishings. Hot water in bathroom one measured 119.1 degrees Fahrenheit and 114.8 degrees Fahrenheit in bathroom two. LPA observed the ceiling light in the laundry room was not operational. LPA and Administrator toured the garage. The garage has a storage room that is used to store extra supplies. The garage is also used to store PPE, food and supplies. The garage is inaccessible to residents. LPA and Administrator toured the back yard. The side exit gate on the garage side of the facility is operational. There is a covered patio with a seating area. LPA observed on the side of the house opposite the garage had ladders and screens in the pathway. No bodies of water observed. LPA and Administrator toured the kitchen. LPA observed the knives are kept locked in a kitchen drawer. LPA observed medications are kept locked in a kitchen cabinet. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. The kitchen is clean and organized. Smoke detector/carbon monoxide detectors tested operational. LPA inspected the first aid kit. The first aid kit had all the required elements. Facility has a mitigation plan that has been approved. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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