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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604528
Report Date: 05/10/2022
Date Signed: 05/16/2022 06:31:21 PM


Document Has Been Signed on 05/16/2022 06:31 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:SUNSET VILLA ASSISTED LIVINGFACILITY NUMBER:
134604528
ADMINISTRATOR:KAHNIS, QUETZALLIFACILITY TYPE:
740
ADDRESS:1203 DRIFTWOOD DRIVETELEPHONE:
(760) 592-4001
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:12CENSUS: 0DATE:
05/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kevin Kahnis- AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an announced Pre-Licensing visit. LPA was joined by Applicant Kevin Kahnis and granted entry into the facility. The purpose of the visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 01/07/22, and the facility was approved for 8 nonambulatory residents and 4 bedridden residents.

During today's visit, LPA, accompanied by applicant, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Clients' bedrooms were observed to be clean and resident accommodations included furnishings, linens and personal hygiene items; resident bathrooms were equipped with grab bars, bath mats; staff and administrative records are located in a locked office; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in the garage or the office; medication storage and administration logs are located in a locked cabinet in the kitchen; first aid kit and current first aid manual are located in the office; activities, supplies and sufficient space to conduct are present; fire extinguishers are affixed with a current tag; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility administrators certification is current; no pools or other body of water is present on the facility; per the applicant there are no guns, weapons or ammunition located on the property. Discussed with the applicant were continuing operation requirements, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application.

An exit interview was conducted with Mr. Kahnis, and a copy of this report and Licensee Appeal Rights (LIC 9058) were were printed and given to Mr. Kahnis at the facility.



SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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