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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006460
Report Date: 01/26/2024
Date Signed: 01/26/2024 03:31:58 PM

Document Has Been Signed on 01/26/2024 03:31 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNRISE GUEST HOME 2FACILITY NUMBER:
306006460
ADMINISTRATOR:OLTEANU, CLAUDIAFACILITY TYPE:
740
ADDRESS:610 SOUTH CAMPBELL DRIVETELEPHONE:
(949) 232-9619
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
01/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Claudia Olteanu - AdministratorTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection for a change of location. This pre-licensing inspection request was expedited due to the owners at the current location planning to sell the house. LPA arrived and was greeted and granted entry by designated Administrator (AD) Claudia Olteanu. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden clients was received by Community Care Licensing (CCL) on 11/07/2023.

Structure: The facility is a one-story home with three client bedrooms, two client bathrooms, living room, dining room, kitchen, attached two car garage, covered patio and backyard. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entryway. There is a back yard with two exit gates. There is a covered patio with seating area in the backyard. LPA did not observe any obstructions blocking the exit gates or obstacles or hazards in the backyard. Three areas of the facility are marked as 'AREA NOT IN USE' because the previous owners of the location on Campbell completed construction that was not approved. The AD stated that they were advised to submit another application to licensing in the future if they would like to get the aforementioned area approved for use.

Client Bedrooms: Client furniture is currently in use at the existing facility. LPA reviewed photos provided by the Designated AD. The photos were taken in the clients’ current rooms at the existing facility. AD stated the facility will be moving all required furnishings for client bedrooms. LPA observed all windows were screened.

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and are stored and locked in a closet near the hallway.

Medications, First-Aid Kit & Book: These items are locked in cabinets in the hallway.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUNRISE GUEST HOME 2
FACILITY NUMBER: 306006460
VISIT DATE: 01/26/2024
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Resident & Staff Files: These items will be locked in the closet near the hallway. AD stated they are building shelves for the files in the mentioned closet.

Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on 1/23/2024.

Fire Extinguisher: LPA observed a service tag for the fire extinguisher which indicates the fire extinguisher was last serviced on 5/12/2023.

Activities: Planned activities include: exercise, educational games, karaoke, lego building and more.

Bathrooms: All bathrooms have working plumbing and designated hand washing posters. Hot water initially measured above 120 degrees Fahrenheit. AD adjusted hot water heater and LPA waited for the hot water to drain from the tank. LPA measured the water again and observed the hot water to measure 108.6 degrees Fahrenheit and 105.6 degrees Fahrenheit. LPA advised AD to maintain a water log as a precaution.

Linens & Hygiene Supplies: A supply of extra towels is stored in the closet in the living room. Extra hygiene supplies are stored in the cabinets in the hallway. Bedding linens will be transferred during the move.

Emergency Numbers/Exit Plan/Menu: Posted for review. A 7-day supply of non-perishable food is on hand.

Smoke Detectors: Smoke detectors and Carbon Monoxide detectors are stationed throughout the home. Both types of detectors were tested and observed to be operational.

Appliances: Stove with oven, refrigerator, dishwasher, microwave, washer/dryer are operational.

Component III: LPA provided information and resources regarding facility compliance, reporting and expectations of LPAs and Licensees.

The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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