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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005479
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:14:55 PM

Document Has Been Signed on 03/11/2025 12:14 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:ROSSMOOR SUNSHINE VILLA-OAK WAYFACILITY NUMBER:
306005479
ADMINISTRATOR/
DIRECTOR:		JULIO NAVALLOFACILITY TYPE:
740
ADDRESS:12772 OAK WAY DRIVETELEPHONE:
(562) 572-9931
CITY:ROSSMOORSTATE: CAZIP CODE:
90720
CAPACITY: 6CENSUS: 5DATE:
03/11/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee- Flormine ResurreccionTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On March 11, 2025, at 10:20 AM, Licensing Program Analyst (LPA) Edward Kim conducted a continuation visit for a required 1-year annual visit that was started on March 4, 2025. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Eloisa Reyes. Licensee Flormine Resurreccion arrived to the facility around 10:30 AM.

LPA Kim conducted an audit review of resident records (R1-R5) and Staff records (S1-S7). LPA conducted one staff interview. First aid kit contains all necessary elements. The facility has operable smoke detectors and carbon monoxide detectors. The facility has a video teleconferencing device dedicated to the residents that remains available

No deficiencies were cited during this visit.

An exit interview was conducted and a copy of this report was provided to Licensee Flormine Resurreccion.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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