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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002478
Report Date: 08/15/2024
Date Signed: 08/15/2024 12:44:41 PM

Document Has Been Signed on 08/15/2024 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNNY CREST GUEST HOME # 1FACILITY NUMBER:
306002478
ADMINISTRATOR/
DIRECTOR:		KENNETH/MARIA HUNTERFACILITY TYPE:
740
ADDRESS:8052 SAN LUCAS CIRCLETELEPHONE:
(714) 229-0662
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 2DATE:
08/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Kenneth HunterTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jerome Haley and Samer Haddadin conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPAs were greeted, granted entry by staff, and explained the reason for the visit before entering the facility. Administrator Maria Hunter contacted Licensee/Administrator Kenneth Hunter who arrived a short time later and was present the remainder of the visit.

Around 09:20 am LPAs began the tour of the facility with staff. There were two residents present for the visit. Right next to the front door there’s a closet with shoes and jackets, and PUB 475 poster hanging next to the front door. Resident bedrooms were clean, organized, and had all the necessary requirements: night stand, chair, lamp, and storage space. Resident bathrooms were clean and organized. Hot water temperature was measured in the range of 112.1 – 118.4 degrees Fahrenheit.

The kitchen was clean and organized. Knives and sharp objects were locked in a drawer near the stove. All burners on the stove were operational. The facility has a two-day supply of perishable food items and seven-day supply of nonperishable food items. There’s a laundry area in the back of the kitchen with a washer, dryer, locked cabinets with a supply of cleaning chemicals, and a pantry area with an additional supply of nonperishable food items.

The backyard had a shaded area with tables and chairs for the residents to enjoy. There's a pool in the backyard surrounded by a 5-foot self-latching gate. There’s a locked storage shed in the backyard used to store various facility items. In the lock storage area, there was an additional refrigerator with a an additional supply of perishable food items, walkers, wheelchairs, and other items.

The garage is lock, off limits to residents, and used as a workshop for the licensee. In the garage, several tools, bicycles, and a motorcycle was observed.

Continued on LIC809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUNNY CREST GUEST HOME # 1
FACILITY NUMBER: 306002478
VISIT DATE: 08/15/2024
NARRATIVE
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All smoke detectors were tested and are operational, and the carbon monoxide detector tested operational. Emergency evacuation drills are conducted quarterly, and the last drill was conducted in April 2024. Licensee/Administrator Kenneth Hunter was advised to keep a log of all the evacuation drills that are conducted and include the name of all staff and residents in attendance. A review of resident files and medications was conducted, as well as a review of 2 staff files.

Deficiencies are being cited as a result of observations made during todays annual inspection.

An exit interview conducted, and a copy of the report and appeal rights were provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/15/2024 12:44 PM - It Cannot Be Edited


Created By: Jerome Haley On 08/15/2024 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNY CREST GUEST HOME # 1
FACILITY NUMBER: 306002478

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(a)(6)
Incidental Medical and Dental Care Services
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview confirmation, the licensee did not comply with the section cited above in 1 out of 2 residents Centrally Stored Medication and Destruction Records which poses an immediate health and safety risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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Licensee/Administrator Kenneth Hunter agrees to update the Centrally Stored Medication and Destruction Record for Resident 1 (R1) and email to LPA by the close of business.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lourdes Montoya
LICENSING EVALUATOR NAME:Jerome Haley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/15/2024 12:44 PM - It Cannot Be Edited


Created By: Jerome Haley On 08/15/2024 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNY CREST GUEST HOME # 1
FACILITY NUMBER: 306002478

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. A pair of scissors was observed unsecured in the kitchen around 9:50 am which posed a potential safety risk to persons in care.
POC Due Date: 08/15/2024
Plan of Correction
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The licensee immediately placed the scissors in the drawer with the rest of the sharp objects. No further action required.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lourdes Montoya
LICENSING EVALUATOR NAME:Jerome Haley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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