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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605409
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:22:43 AM

Document Has Been Signed on 12/02/2024 11:22 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUTTON FOUNDATIONFACILITY NUMBER:
300605409
ADMINISTRATOR/
DIRECTOR:		JORGE G. MONROYFACILITY TYPE:
735
ADDRESS:4101 BELVEDERETELEPHONE:
(949) 651-0778
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 5DATE:
12/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:03 AM
MET WITH:Jorge Gonzalez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8:03 AM. During today’s visit, LPA met with Jorge Gonzalez, Administrator. The facility is a level 4f, single story building with an approved fire clearance of six ambulatory residents of which one may be on hospice. The facility currently has a census of five clients in care. Today four clients were present in the facility and one was at Adult Day Program.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperatures in two of two client bathrooms. The hot water temperature measured between 105.8 and 106.3 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. Sharps and hazardous chemicals were secured. The fire extinguishers were charged and serviced on June 21, 2024. The facility’s last fire drill was conducted on November 1, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand with multiple freezers and an extra pantry in the garage. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. Admissions Agreements are on file from Regional Center and Administrator was advised to create Admissions Agreements to comply with Title 22. LPA interviewed alert clients regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has an administrator certificate which is pending renewal and will expire June 12, 2025. 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 deficiencies cited on this date. An exit interview was conducted with Jorge Gonzalez, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859), and LIC 9102-TV were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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