300605409-9-15-2022-22-AS-AMEL-CJATZH-20220915151022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605409
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:10:26 PM

Document Has Been Signed on 09/15/2022 03:10 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SUTTON FOUNDATION		FACILITY NUMBER:	300605409
ADMINISTRATOR:	JORGE G. MONROY		FACILITY TYPE:	735
ADDRESS:	4101 BELVEDERE		TELEPHONE:	(949) 651-0778
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY: 6		CENSUS: 6	DATE:	09/15/2022
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator, Jorge Gonzalez		TIME COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into facility by Jorge Gonzalez, Administrator and explained the reason for the visit. Administrator Dulce Flores arrived at 2:00 PM.

At 1:25 PM, LPA toured facility with Administrator Jorge Gonzalez. Facility has 6 clients present during today’s visit. Facility is a 4 bedroom, 2 bathroom, single story home with an attached garage. LPA observed a screening and sanitizing station at entrance of the facility. LPA observed clients relaxing in the facility or in their respective rooms. Facility appears clean and sanitary. All clients rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and have hand washing postings. Facility has 2 refrigerators with ample food supply. LPA observed facility has emergency food and water supply. Facility has a secured location for client medication and files. LPA toured the outside grounds and observed outside visitation area. Exit gate is unlocked and self latching. Facility has a plan for covid testing clients and staff as needed as well as a plan for isolation. LPA observed a 4 weeks supply of PPE. LPA reviewed all clients files and all contained required documentation including updated emergency information. All staff and clients are vaccinated for COVID-19.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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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