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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600321
Report Date: 11/19/2021
Date Signed: 11/19/2021 07:30:38 PM

Document Has Been Signed on 11/19/2021 07:30 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNNYSIDE RETIREMENT CENTERFACILITY NUMBER:
198600321
ADMINISTRATOR:ANGELES, JENNYLYNFACILITY TYPE:
735
ADDRESS:22713 SOUTH VERMONT AVENUETELEPHONE:
(310) 320-3318
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 48CENSUS: 42DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Jennylyn Angeles - AdministratorTIME COMPLETED:
03:15 PM
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On 11/19/2021, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Administrator Jennylyn Angeles and explained the purpose of today’s visit. The facility is licensed to operate for forty-eight (48) ambulatory mentally disordered adults between the ages of 18 through 59.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: twenty-four (24) client rooms and each room has its own bathroom, one (1) staff room, one (1) Administrator office, one (1) lobby/main entrance area equipped with television, one (1) dining room, kitchen, one (1) medication room, three (3) storage rooms in lobby area, dedicated laundry room area and an outside patio quad area including a canopy for shade. The kitchen includes a walk-in refrigerator and freezer. There are two (2) food and drink vending machines located in the lobby area.

LPA and Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Various rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 109.3 F to 113.4 F in the bathrooms of room #107, #120 and #121. A comfortable temperature was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies and toxins were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available that is maintained properly.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SUNNYSIDE RETIREMENT CENTER
FACILITY NUMBER: 198600321
VISIT DATE: 11/19/2021
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The facility has posted the planned activities calendar for the month in the lobby. A review of Medication Records Administration (MAR) were observed to be maintained in order and accurate. Medications are locked up in the medication room and inaccessible to clients.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

Advisory Notes – One (1) Technical Assistance was issued, please see LIC9102-AN.

An exit interview was conducted and a copy of this report was provided to Administrator Jennylyn Angeles.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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