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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802272
Report Date: 09/30/2024
Date Signed: 09/30/2024 01:39:19 PM

Document Has Been Signed on 09/30/2024 01:39 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE TERRACE RCFE IIFACILITY NUMBER:
405802272
ADMINISTRATOR/
DIRECTOR:		SADORRA, HECTORFACILITY TYPE:
740
ADDRESS:1338 ROYAL WAYTELEPHONE:
(805) 541-1843
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 6CENSUS: 3DATE:
09/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:54 AM
MET WITH:Licensee, Edwin InganTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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 At 11:50am on 09/30/2024, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee Edwin Ingan,, announced who he was and the reason for the visit.

This facility is a 5 bedroom, 3 bathroom, living room, small dinette/pantry table room, kitchen, dining room, backyard and front yard. Bedroom Number 1 and 5 is a dual resident occupancy and the other 3 bedrooms are single resident occupancy. Bedroom one has an on suite bathroom for residents use and the other two bathrooms are available for use for all facility residents. Both backyard and front yard have tables and umbrellas that provided shade in the outside areas of the facility. All bedrooms meet regulations requirements with lighting, linin and storage. There is liquid soap and paper towels in all bathrooms, and water temperature was tested with in regulation range of 105*-120* (f). The facility has working smoke detectors throughout the facility and a working carbon monoxide detector. There is a fire extinguisher located in the green in the dining room. All exits were observed by LPA to be free and clear of obstructions. All required postings are located in the entry way and in the small dinette area of the facility. LPA observed at least 2 days of perishable and at least 7 days on non-perishable foods. Medications are secured and stored in the entrance hallway closet. LPA observed the facility to be clean and in good repair.

LPA and Licensee did a complete review of the inspection care tools, LPA noted that there was one violation as noted above. LPA interviewed 1 of 1 staff and 1 of 3 residents. Two other resident were about in the community with family.

Report read, report singed, report and provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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