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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605163
Report Date: 04/24/2024
Date Signed: 04/24/2024 12:33:00 PM

Document Has Been Signed on 04/24/2024 12:33 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUTTON FOUNDATION - MARGARITA HOMEFACILITY NUMBER:
300605163
ADMINISTRATOR/
DIRECTOR:
JORGE G MONROYFACILITY TYPE:
735
ADDRESS:4251 MARGARITATELEPHONE:
(949) 651-0660
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 5DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:49 AM
MET WITH:Jorge Gonzalez and Dulce FloresTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Michael Tea and Rose Ruppert and Licensing Program Manager (LPM) Alisa Ortiz made an unannounced visit to the facility today to conduct an Annual Random/Required Evaluation. LPAs and LPM was greeted and granted entry by Rosa Lopez, a caregiver. During today’s visit, LPAs and LPM met with Jorge Gonzalez and Dulce Flores, both administrators.

The facility is a single story building with an approved fire clearance of six ambulatory residents. The facility currently has a census of five residents in care.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two resident bathrooms, and testing auditory devices on all exits, The hot water temperature measured between 120.2 and 126.8 degrees F and all smoke detectors were operational. The facility’s last fire drill was conducted on January 17, 2024. LPAs and LPM inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review completed medication appear to be being given as prescribed.

LPAs reviewed five of nine staff training and fingerprint records. LPA reviewed five of five resident records. LPA Ruppert interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided.


Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiency cited on this date. An exit interview was conducted with Jorge Gonzalez and Dulce Flores and a copy of the report was given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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