197603807-9-27-2022-31-AS-APAA-CJNRJ8-20220927130333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603807
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:04:17 PM

Document Has Been Signed on 09/27/2022 01:04 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 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: 128	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Liz Kaplan, Business Office Coordinator		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Angela Panushkina conducted an Annual Required visit and inspection of the facility. LPA met with a Business Office Coordinator and explained the reason for the visit.

Infection Control: Upon entrance, staff took LPA’s temperature and was asked to sign-in the visitor’s log. Facility has sufficient PPE supplies for more than 30 days. Staff were observed wearing proper face masks.

At 11:20am, LPA toured the facility and observed the following: The facility is a large 2 story building with a Memory Care Unit. In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment.

Food Inspection: Kitchen and dining area are located on the ground floor of the facility. LPA observed there was sufficient stock of one week non-perishable foods and two days perishable food. Kitchen was observed to be sanitary and free of pests.

Smoke detectors/carbon monoxide are hardwired and located throughout the facility. Fire alarms are program to dispatch the Fire Department. Therefore, LPA obtained paperwork for the last fire alarm inspection which was conducted on 10/13/21. Fire extinguishers were observed to be charged with a service date of 04/18/22.

Common Areas: Common areas consists of front lobby sitting area, activity rooms, in Assistance Living, and Memory Care Unit. All areas were properly furnished and sanitary with sufficient room for residents to lounge. Facility also has a beauty salon located on the ground floor. Laundry area is located on a second floor of the facility. Facility has two MedTech rooms, one is located inside the Memory Care Unit and the second room is on an Assisted Living side. LPA observed both rooms inside the Memory Care Unit and the second room is on

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: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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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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: 09/27/2022

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an Assisted Living side. LPA observed both rooms were kept locked and inaccessible to residents in care.

Resident Rooms: Facility consists of 86 rooms. Rooms consists of single or shared occupancy. A random selection of bedrooms was toured both in Memory Care and Assisted Living. All bedrooms were properly furnished and had appropriate bed linens. Rooms were observed to be sanitary.

Bathrooms: Bathrooms were toured and observed to be clean and properly stocked with towels and soap. Nonskid mats and grab bars were observed in all bathrooms.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation.

Outside: LPA toured the outside area of the facility. LPA observed two private patios with appropriate outside furniture and shaded area for residents. During the time of the inspection, LPA observed activities being conducted with Memory Care residents and Assisted Living residents

No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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