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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608023
Report Date: 09/19/2022
Date Signed: 09/19/2022 09:51:18 AM

Document Has Been Signed on 09/19/2022 09:51 AM - 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:SUNGATE CARE FACILITYFACILITY NUMBER:
197608023
ADMINISTRATOR:TASHA KANALEYFACILITY TYPE:
735
ADDRESS:3441 SUNGATE DR.TELEPHONE:
(661) 526-7848
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 4DATE:
09/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Dolly BarrazaTIME COMPLETED:
08:45 AM
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LPA Spaeth conducted an unannounced annual visit. LPA arrived at 7:50 am and observed the COVID signs at the front door. LPA was greeted by two caregivers and was escorted to the living room. LPA Spaeth stated the purpose of the visit is to complete an annual inspection. LPA was asked the COVID questions and LPA's temperature was taken .LPA observed the sign in station which contained hand sanitizer, sign in sheet, thermometer and masks. LPA observed both caregivers were wearing a mask

LPA Spaeth and caregiver began the tour of the facility at 7:50 am. LPA observed the family room, dining room and kitchen are all combined together. LPA entered the kitchen and observed wash your hands sign, hand soap, paper towels and a trash can. LPA observed the pantry was well organized and contained an adequate supply of canned goods and cereal. The frozen section of the refrigerator contained frozen meats and vegetables. The refrigerator was well stocked with fresh fruits, fresh vegetables, juice, and other fresh food items. All food was covered and labeled. The facility contained a seven day supply of canned goods and a two-day supply of fresh food items. LPA observed the facility menu was posted on the refrigerator. LPA observed the family room and living room contained comfortable seating for the residents. LPA observed the common areas of the facility were clean and all furniture was in good repair.

LPA observed a locked, hall closet which contained the knives locked in a plastic container and the resident medications. LPA observed a 90 day supply of PPE which includes N95 masks, surgical masks, hand sanitizer, gloves, and other items. Also, linens were stored in the hallway storage area for the residents. The four resident bedrooms contained lamp, night stand, bed, linens and chest of drawers. The two bathrooms contained trash can, wash your hands sign, hand soap, and paper towels. LPA observed the backyard contained comfortable seating. The laundry room was locked and contained washer/dryer and cleaning supplies.
There are no deficiencies to report at this time. Exit interview conducted, appeal rights discussed, and a copy of the signe report was given to the caregiver.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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