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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604607
Report Date: 02/18/2025
Date Signed: 02/18/2025 01:08:59 PM

Document Has Been Signed on 02/18/2025 01:08 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SUNSET RESIDENTIAL CARE IFACILITY NUMBER:
374604607
ADMINISTRATOR/
DIRECTOR:		LOPEZ, YANET PUENTESFACILITY TYPE:
740
ADDRESS:2707 NANSEN AVETELEPHONE:
(858) 352-6340
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 3DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Administrator Yanet Puente LopezTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to caregiver and Romelia Solis and private caregiver Maria Del Rio. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. The facility is also approved for six (6) hospice residents. During today’s inspection there were three (3) residents in care.
 
LPA and Caregiver Damian Ordaz Arencibia toured the interior and exterior of the facility and inspected each room. Administrator Yanet Puente Lopez joined later in the visit. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink was 105F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and secured.

[Continued on LIC 809-C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNSET RESIDENTIAL CARE I
FACILITY NUMBER: 374604607
VISIT DATE: 02/18/2025
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[Continued from LIC 809]

During the tour, LPA noticed the doorway from the kitchen to the garage was not secured, presenting a risk for residents in accessing toxic chemicals and poisons kept in the garage.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per caregiver Damian, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed (2) staff and (0) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents, and it was revealed a private caregiver was present and working at the facility without a criminal background clearance. Confidential records were stored in locked areas.

Two (2) deficiencies were cited during the inspection. An exit interview was conducted with Administrator Yanet Puente Lopez to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/18/2025 01:08 PM - It Cannot Be Edited


Created By: Arian Golbakhsh On 02/18/2025 at 12:16 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNSET RESIDENTIAL CARE I
FACILITY NUMBER: 374604607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and interviews, the licensee did not comply with the section cited above in securing sharps and toxic chemicals, which poses an immediate health and safety risk to three out of three (3 out of 3) persons in care.
POC Due Date: 02/25/2025
Plan of Correction
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Licensee immediately locked and secured sharps present and changed the lock to the unsecured door leading to where chemicals are kept.
Type A
Section Cited
CCR
87412(b)(3)(B)
Personnel Records
(b) Personnel records shall be maintained for all volunteers and shall contain the following: (3) For volunteers that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, records review, and interviews, the licensee did not comply with the section cited above in ensuring private companions were working with a criminal exemption clearance, presenting a health and safety risk to three out of three (3 out of 3) persons in care.
POC Due Date: 02/25/2025
Plan of Correction
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Licensee informed private care staff that they cannot work or be present at the facility until a criminal records clearance letter is provided. Licensee will also send a copy of the criminal records clearance by the POC due date to LPA.
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:Jennifer Lott
LICENSING EVALUATOR NAME:Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


LIC809 (FAS) - (06/04)
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