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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605163
Report Date: 02/16/2023
Date Signed: 02/17/2023 08:11:39 AM

Document Has Been Signed on 02/17/2023 08:11 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUTTON FOUNDATION - MARGARITA HOMEFACILITY NUMBER:
300605163
ADMINISTRATOR:JORGE G MONROYFACILITY TYPE:
735
ADDRESS:4251 MARGARITATELEPHONE:
(949) 651-0660
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 6DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jorge MonroyTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control. LPA Martinez met with Administrator Jorge G. Monroy and reason for the visit was explained. Staff confirmed there are currently no cases or exposures of COVID-19 within the facility.

During the inspection, LPA noted the 2 staff present, wearing mask. LPA observed 3 clients present and 3 were at Program. LPA confirmed all clients are doing well and observed no health and safety issues. LPA inspected common areas, client rooms, kitchen, garage and were observed to be clean and organized. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. LPA observed hallways and walkways were free of obstruction.

LPA reviewed and confirmed facility policies and practices regarding client screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, and communication and emergency plan. LPA requested and reviewed the client roster, the COVID-19 Mitigation Plan, and Emergency Disaster Plan. LPA discussed PIN 23-03, stated he understood and had no questions.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report will be emailed to Administrator Monroy.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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