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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005630
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:16:06 AM

Document Has Been Signed on 03/05/2025 11:16 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:STERLING SENIOR COMMUNITY IFACILITY NUMBER:
306005630
ADMINISTRATOR/
DIRECTOR:		PASCUAL, KIANFACILITY TYPE:
740
ADDRESS:6081 IVORY CIRCLETELEPHONE:
(714) 357-1377
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Kian PascualTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by caregiver. Kian Pascual arrived at the facility and met with LPA. There are four residents at the facility and there are no residents receiving hospice services currently.

LPA accompanied by caregiver began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. The facility stays within the capacity limitations. There is a minimum of one week of non-perishables located in garage pantry. There is two perishables food available and there is additional food storage in a freezer and in an additional refrigerator located in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the living room. LPA reviewed medication and cross checked with medication logs. Medication was observed to be labeled and stored inaccessible to residents in care. LPA inspected the facility bathrooms and LPA measure the hot water temperature which measured 113.5 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathroom are equipped with required safety measures such as non-skid mats and grab bars. Lighting I sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solution and disinfectant are store locked in a storage cabinet locate in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedroom which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways to be free of obstruction. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher mounted on the wall of the dining room with a service date of December 3, 2024. LPA reviewed

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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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: STERLING SENIOR COMMUNITY I
FACILITY NUMBER: 306005630
VISIT DATE: 03/05/2025
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fire drill logs and verified drills are conducted quarterly with last fire drill conducted January 1, 2025. LPA began review of records; LPA reviewed four resident records. All the required documentation was present and current in the residents’ file review. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed a current Administrator Certificate mounted on the wall on the facility. LPA observed a current first aid certificate on file for employee.

Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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