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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006007
Report Date: 03/08/2022
Date Signed: 03/23/2022 11:45:13 AM

Document Has Been Signed on 03/23/2022 11:45 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:STERLING SENIOR COMMUNITY VIFACILITY NUMBER:
306006007
ADMINISTRATOR:KELLOGG, MICHELLEFACILITY TYPE:
740
ADDRESS:140 N WHEELER STTELEPHONE:
(714) 538-9615
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 6DATE:
03/08/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Claudia CockrumTIME COMPLETED:
05:00 PM
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This report was created in error. The correct facility in which the required annual was conducted was Sterling Senior Community 4, #306005704.

Licensing Program Analyst (LPA) Kathrina Chin made an unannounced required annual inspection in this facility. LPA met with Claudia Cockrum, caregiver and stated the purpose of this visit.

The facility is a single level structure and licensed for six non-ambulatory residents of which one may be bedridden. There are five residents on hospice care.

LPA Chin was granted entry after completing the COVID 19 screening procedure. For this visit, there are six residents in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid - floor mats. Hot water was measured at 120 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outdoor furniture and covered patio. The grounds were free of tripping hazards. Side exit door was self-latching and self-closing. LPA Chin reviewed the COVID 19 mitigation plan of the facility.

For this visit, there are no deficiencies cited this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted with Claudia Cockrum, caregiver and copy of this report was left in the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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