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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290150
Report Date: 05/03/2022
Date Signed: 05/03/2022 12:45:19 PM

Document Has Been Signed on 05/03/2022 12:45 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE ADULT DEVELOPMENT CENTERFACILITY NUMBER:
191290150
ADMINISTRATOR:GLORIA ALLISONFACILITY TYPE:
775
ADDRESS:29890 BOUQUET CANYON ROADTELEPHONE:
(661) 296-8636
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 49CENSUS: DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Kathleen Sturkey, Executive DirectorTIME COMPLETED:
12:09 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 (LPA) Abeye Duguma met with Kathleen Sturkey for a One (1) Year Required - Infection Control visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:15am and the following was noted:
There are multiple entrances being utilized at the facility to access different rooms, however, all participants are screened prior to transitioning from room to room. The facility has enough PPE supplies. There are required posters posted at the main door. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks. Signs to wear masks and other COVID 19 prevention protocol signs are posted outside. Hand washing, coughing etiquette, physical distancing and other necessary signs are posted in the bathroom and throughout the facility. The facility is fire cleared for nine (09) non-ambulatory, forty (40) ambulatory. The facility has a covered shaded area for residents and visitors. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is currently not in use as the facility has been closed for over two years. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to clients. Furniture are neat and clean. The facility maintains a comfortable temperature at 72°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers are near all entrances, observed to be full and last inspected on 01/18/2022. LPA observed medication and first aid kit to be locked and inaccessible to clients. Residents have enough hygiene products provided by the licensee. The bathrooms were checked for cleanliness and proper operations. The facility has a swimming pool with appropriate fencing. The hot water temperature was measured at 106.3°F.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2022
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 1