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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005651
Report Date:
12/28/2021
Date Signed:
12/28/2021 03:44:38 PM
Document Has Been Signed on
12/28/2021 03:44 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
CCLD Regional Office
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
SUNRISE GARDEN
FACILITY NUMBER:
306005651
ADMINISTRATOR:
PARDEDE, FERDINAND
FACILITY TYPE:
740
ADDRESS:
29751 ANA MARIA LANE
TELEPHONE:
(949) 423-6175
CITY:
LAGUNA NIGUEL
STATE:
CA
ZIP CODE:
92677
CAPACITY:
6
CENSUS:
3
DATE:
12/28/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:25 PM
MET WITH:
Cherry Alfonso
TIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. LPA observed all resident bedrooms had the required furnishings. All bedrooms were clean and organized and had enough space to accommodate the residents and their belongings. LPA observed all 5 bathrooms were clean and organized. Hot water temperature measured 117.0 degrees Fahrenheit. LPA observed a 2 day supply of perishable food and a 7 day supply of non-perishable food on hand in the kitchen. The kitchen was clean and organized. Knives are kept locked in a kitchen drawer and medications are kept locked in a kitchen cabinet. The garage is used for storage and kept locked. The smoke detectors/carbon monoxide detectors tested operational. All fire extinguishers are fully charged. LPA and staff toured the backyard. No bodies of water observed. Both exit gates are operational. No obstacles or hazards observed. The patio has a table and chairs to sit outside. Facility has a mitigation plan that is pending review. 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:
12/28/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/28/2021
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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