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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005917
Report Date: 06/16/2022
Date Signed: 06/16/2022 11:24:08 AM

Document Has Been Signed on 06/16/2022 11:24 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNRAYS BOARD & CAREFACILITY NUMBER:
306005917
ADMINISTRATOR:TINIO, RAYMONDFACILITY TYPE:
740
ADDRESS:7120 FILLMORE DR.TELEPHONE:
(562) 310-5772
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: DATE:
06/16/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Carel Velarde, Grecia Balladres, Raymond TinioTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with staff Carel Veladre, Grecia Balladares and stated the purpose of this visit. Administrator Raymond Tinio arrived during the inspection to provide assistance.

The facility is a single level structure and licensed for six non-ambulatory of which one can be bedridden and six can be on hospice. This facility offers Residential Care for the Elderly.

At about 8:53 am, LPA Tapia was granted entry however, was not asked to complete the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed one resident in care and two staff members on duty. LPA toured the interior and exterior portions of the facility. There were four resident rooms one of which could be shared room. One room was for the staff. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide, and auditory exit alarms were tested to be operational. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 131.1 degrees Fahrenheit. Bathroom (2) was observed to be in good repair and provided with grab bars and hot water was measured at 130.8 degrees Fahrenheit. Administrator was made aware of water temperature. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements, cleaning supplies inaccessible to residents in care. Facility also had emergency food for resident in care. Facility did have personal protective equipment in place but are in need of gowns and N95 masks. Administrator will obtain the necessary PPE equipment. Fire extinguisher was observed to be charged and operational. However, fire extinguisher was expired. Administrator was made aware of this matter and will have fire extinguisher replaced. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUNRAYS BOARD & CARE
FACILITY NUMBER: 306005917
VISIT DATE: 06/16/2022
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Facility also had an attached 2 car garage which is used for storage and contained an operational washer and dryer. Kitchen was in good repair with cleaning supplies kept locked. LPA noticed some unused knifes where not locked and staff immediately removed them and locked them away so no resident could access them. LPA Tapia also notice first aid kit was not locked and informed staff that all medication/medical suppies need to be locked. LPA Tapia reviewed the COVID 19 mitigation plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. Four advisories were issued today.

LPA Tapia conducted an exit interview with Administrator Raymond Tinio and copy of this report was explained and left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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