<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006359
Report Date: 07/08/2024
Date Signed: 07/09/2024 08:43:04 AM

Document Has Been Signed on 07/09/2024 08:43 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNSET HOMESFACILITY NUMBER:
306006359
ADMINISTRATOR/
DIRECTOR:		DAHBOUR, ALBERTFACILITY TYPE:
740
ADDRESS:30741 PASEO DEL NIGUELTELEPHONE:
(949) 363-1498
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 6DATE:
07/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Albert DahbourTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with the Administrator Albert Dahbour. LPA explained the reason for the visit. LPA observed the See Something, Say Something sign mounted in the entry way of the facility is 8 1/2 by 11 inches in size. LPA toured the facility. LPA observed that the 3 car garage is now a 2 car garage. The area that was for the third car has been converted into 3 rooms. The first room closest to the door leading into the dining room has office furniture and a mattress. The second room has two twin beds set up in it. The third room has a mattress leaning on the wall in it. The facility sketch mounted in the entry way of the facility shows the garage but not the 3 rooms. The rest of the garage is used for storage. Smoke detectors and the carbon dioxide detector tested operational. The fire extinguisher mounted in the dining room is fully charged. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked under the kitchen sink. LPA and the Administrator toured the resident bedrooms. All resident bedrooms were clean and organized. All the resident bedrooms had the required furniture and bed linens. LPA observed all 4 bathrooms are clean and operational. Hot water measured from 113.0 degrees Fahrenheit to 115.1 degrees Fahrenheit in the bathrooms. LPA observed medication is kept locked in a cabinet in the dining room. LPA and the Administrator toured the backyard. No bodies of water observed. There is a table with and umbrella for shade and 4 chairs for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 6 resident files and medications. No discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members had the required 20 hours of annual training. Both staff members had current CPR training. LPA observed the facility has WiFi and a tablet for resident use. LPA interviewed staff and residents. No obstacles or hazards observed inside the facility. Deficiencies are being cited per title 22 Division 6 of the California Code of Regulations on the attached LIC 809D. An exit interview was conducted with the Administrator and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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
Document Has Been Signed on 07/09/2024 08:43 AM - It Cannot Be Edited


Created By: Joseph Alejandre On 07/08/2024 at 05:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNSET HOMES
FACILITY NUMBER: 306006359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above, LPA observed the 3 car garage is now a 2 car garage, the area that was for the third car has been converted into 3 rooms. The facility's fire clearance is no longer valid since the facility footprint/sketch has been changed from it's original footprint/sketch when the license was granted, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/09/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain a building permit from the city (for the 3 rooms in the garage), complete a new application (LIC 200), submit the LIC 200 along with a new facility sketch to start the process to obtain a new fire clearance. Licensee agrees to adhere to the regulation cited above and to sign a statement of understanding to the LPA by the POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2