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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005704
Report Date: 03/21/2025
Date Signed: 03/21/2025 04:10:18 PM

Document Has Been Signed on 03/21/2025 04:10 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:STERLING SENIOR COMMUNITY 4FACILITY NUMBER:
306005704
ADMINISTRATOR/
DIRECTOR:		MICHELLE KELLOGGFACILITY TYPE:
740
ADDRESS:150 N WHEELER STREETTELEPHONE:
(714) 912-3004
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 4DATE:
03/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:Roderick Hernandez-Caregiver, Dennis Bermudez-Caregiver, Kian Pascual-Administrator Assistant TIME VISIT/
INSPECTION COMPLETED:
04:24 PM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Roderick Hernandez.

For today’s visit, LPA observed a total of four residents in care and two staff members on duty.

LPA observed the Administrator's Certificate for facility AD Adriana Millan which expires on November 07, 2025.

LPA Ramirez toured the interior and exterior portions of the facility with caregiver Bermudez. The facility is a single level structure and is licensed for six non-ambulatory residents, of which four may be on hospice and one bedridden. For this visit, there are a total of four residents in care. There are a total of six bedrooms, of which five are private resident bedrooms, and one private bedroom for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of three restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 109.4-11.5 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care.

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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 4
FACILITY NUMBER: 306005704
VISIT DATE: 03/21/2025
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LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the main entrance hallway. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. Medications are locked in a cabinet by bedroom five.

For the exterior portion, LPA Ramirez observed a shaded patio and sitting area, and the grounds were free of any hazards. There is one gate in the backyard, which is self-closing and self-latching. No bodies of water were observed.

LPA advised facility representative to use the updated Health Screening Report (LIC503) dated June 2024.

LPA reviewed four resident files and two staff files. LPA interviewed residents and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with staff representative.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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