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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005710
Report Date: 02/28/2025
Date Signed: 02/28/2025 03:01:00 PM

Document Has Been Signed on 02/28/2025 03:01 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 IIIFACILITY NUMBER:
306005710
ADMINISTRATOR/
DIRECTOR:		NAREZ, ALBERT PIMENTELFACILITY TYPE:
740
ADDRESS:14631 SHINKLE CIRCLETELEPHONE:
(657) 400-9561
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 6DATE:
02/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Hangki AriTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On February 28th, 2025 Licensing Program Analyst (LPA) William Vanegas made and unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Hangki Ari. LPA Vanegas explained the purpose of the visit and began to conduct a tour of the facility and observed the following.

This is a one storied home with five bedrooms one of which is a staff room. There are two bathrooms that are available to residents in care. There is a detached one car garage as well. LPA Vanegas observed kitchen area clean and free of debris. LPA Vanegas observed there to be a dishwasher, microwave, gas stove, and refrigerator all in good repair and in working condition. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non perishable food on hand. LPA Vanegas observed a sufficient amount of emergency water on hand as well.

LPA Vanegas observed fire extinguisher to be fully charged and up to date, and for carbon monoxide detectors to be in good condition and tested to be operational. LPA Vanegas observed resident bathrooms to be clean and free of mildew and debris. LPA Vanegas observed bathrooms to have all required furnishings such as a shower chair, grab bars, and slip resistant floor matts. Water faucets and toilets tested to be operational. Water tested between and .

LPA Vanegas observed all resident rooms to have all required furnishings such as chest drawers, enough storage space, screened windows, a bed, a lamp, and clean linens meaning no strains or tears. The rooms are big enough to move freely with no obstructions blocking entry ways.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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 III
FACILITY NUMBER: 306005710
VISIT DATE: 02/28/2025
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LPA Vanegas observed outside of the facility to be clean and free of debris with no items blocking the emergency exit paths. Side doors are self latching and are not looked. Backyard is big enough to participate in out door activities upon resident request. There is also an outdoor shaded sitting area.

LPA Vanegas observed first aid kit to have all the required materials such as adhesive tape, scissors, tweezers, bandages, and a thermometer. LPA Vanegas observed all toxins, medications, and sharps to be locked away, and inaccessible to residents in care.

LPA Vanegas reviewed all medications with Assistant Administrator (AA) Arnold Mendoza and observed the medications to be documented correctly and per LPA Vanegas review all medications are being administered per physicians orderes. LPA Vanegas reviewed two staff files and six resident files. After review all documents (Staff and Resident) contain all required documentation and annual staff training is up to date and documented correctly.

Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
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