197603807-10-14-2021-31-AS-APAA-C7SSA4-20211014134144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603807
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:42:47 PM

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 AT STERLING CANYON		FACILITY NUMBER:	197603807
ADMINISTRATOR:	BERRY, TAMARA		FACILITY TYPE:	740
ADDRESS:	25815 MCBEAN PKWY		TELEPHONE:	(661) 253-3551
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	140	CENSUS: 117	DATE:	10/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Tamara Berry, Administrator		TIME COMPLETED:	02:10 PM

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At 10:25 am Licensing Program Analysts (LPAs) Angela Panushkina and Shira Stamps conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by staff who granted access to the facility. LPAs met with Administrator, Tamara Berry. A physical tour was conducted at 10:45 am and observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 4/20/21) to make sure licensee was following current infection control recommendations. Upon arrival, staff took LPAs temperatures and was asked to sign-in the visitors’ log and were asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for residents and staff. Team observed some trash can throughout the facility to not have fitted lids. Team requested that lids be placed on all trash cans to protect from cross from contamination.

Food Inspection: At 11:24am Team observed there to be sufficient supply of two day perishable foods and one week of non-perishable food supply. Food storage and preparation areas are clean and inaccessible to pests. LPAs observed the emergency food supply with a shelf life of 10 years. Team also observed sharp objects being locked and inaccessible to residents in care.

Smoke detectors/carbon monoxide are hard wire and tested yearly by the local Fire Department. LPA requested a copy of the report at 11:00am.

Resident rooms: All residents bedrooms were properly furnished, had sufficient lighting and appeared to be clean and had appropriate bedding. Rooms were kept in a comfortable temperature between 64°F and 72°F.

Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE AT STERLING CANYON	FACILITY NUMBER: 197603807
	VISIT DATE: 10/14/2021

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At 11:30am the team inspected the memory care unit. The egress systems and staff response time was tested. The egress system was found to be operational. Three staff members responded in a timely manner.

Bathrooms: The hot water temperature, in various bathrooms, was measured within regulation from 111.3°F -116.5°F. LPA observed appropriate hand washing signs posted in each bathroom, grab bars and non-skid mat.

Laundry service: At approximately 11:08 am, LPA team toured through the first floor laundry area and observed cleaning products/chemicals inaccessible to residents. At 11:21am the team toured the 2nd floor laundry area and observed cleaning products/chemicals inaccessible to residents.

Medications: Team observed 2 medication carts to be locked and inaccessible to persons in care.

Outside areas: At 11:40am LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water.

LPAs requested LIC 500, Facility License, and Resident Roster,
No deficiencies issued.

Exit interview conducted and a copy of this report was given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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