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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605337
Report Date: 09/30/2021
Date Signed: 09/30/2021 11:57:09 AM

Document Has Been Signed on 09/30/2021 11:57 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 - REDROCKFACILITY NUMBER:
300605337
ADMINISTRATOR:DULCE FLORESFACILITY TYPE:
735
ADDRESS:21 REDROCK IRVINETELEPHONE:
(949) 551-2141
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 6DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrators, Dulce Flores and George GonzalezTIME COMPLETED:
12:15 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and was granted entry into the facility by staff. Upon entry LPA's temperature was checked and logged. LPA explained the reason for the visit.

During the visit LPA toured the facility with Administrators , Facility is a 3 bedroom and 2 bathroom single story home. There are 6 Clients in care. LPA observed facility has required Department postings. LPA toured all clients rooms, all rooms where within regulations. All restrooms observed contained working water basin, soap, toilet paper and towels. Clients were observed relaxing in living room and bedrooms.

Facility has ample supply of PPE supplies. Facility has 2 refrigerators and pantry's with ample food supply. LPA observed facility has emergency food and water supply. Facility has 2 fire extinguishers fully charged. Facility has evacuation plan posted. Facility has a secured location for Client medication and files. Facility has 30 days supply of medications for clients. LPA reviewed Clients files during visit. Clients emergency contact information and physicians reports are current. Facility has designated visitation area.

An exit interview was conducted with Administrator and copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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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