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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290150
Report Date: 12/14/2023
Date Signed: 12/14/2023 03:21:51 PM

Document Has Been Signed on 12/14/2023 03:21 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: 0DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Chris Bratzel, Co-administratorTIME COMPLETED:
03:21 PM
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Licensing Program Analyst (LPA) Abeye Duguma met with Cris Bratzel for a One (1) Year Required 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. The facility has enough PPE supplies. 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 three 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 75°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 02/06/2023. 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 109.2°F.

No health and safety hazards noted during the visit.

Exit interview conducted.

Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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