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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002636
Report Date: 05/24/2021
Date Signed: 05/26/2021 08:07:44 AM

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:SUNFLOWER LIVINGFACILITY NUMBER:
306002636
ADMINISTRATOR:SUNITA CHANDFACILITY TYPE:
740
ADDRESS:9282 BLANCHE AVENUETELEPHONE:
(714) 534-7872
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 4DATE:
05/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:44 AM
MET WITH:Sunita Chand, AdministratorTIME COMPLETED:
11:24 AM
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Licensing Program Analyst (LPA) Jim August conducted an unannounced visit to Sunflower Living. The purpose of today’s visit was to conduct the Required 1 year inspection. LPA was allowed entry into the home and met with Caregiver Judy Jongay. Administrator Sunita Chand arrived shortly after. Administrator Chand has an administrator certificate expiring on June 15, 2021. Facility is licensed for a capacity of 6 residents of which 6 may be non-ambulatory.

LPA August along with Administrator Chand toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, 2 staff bedroom, 4 bathrooms, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 114.8 and 115.6 degrees in resident bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Exit alarms tested operational during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps and cleaning supplies in locked kitchen cabinets. LPA toured the attached locked garage and observed additional food, water and emergency supplies. The facility has a 4 car garage in the backyard which is used for staff and kept locked. The pool is not in use and is fenced with a lock at all times. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers were fully charged. Outside grounds were toured and no bodies of water were observed. There are no security bars or weapons on the premises. Exit gate is unlocked and self latching. LPA reviewed all resident files and 2 staff files. Resident files reviewed contained the required documentation including admission agreements, physician reports and needs and services plans. Staff files reviewed contained fingerprint clearance, health screens, first aid and documentation of required annual training. CONTINUED ON LIC 809C DATED May 24 2021...

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James AugustTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUNFLOWER LIVING
FACILITY NUMBER: 306002636
VISIT DATE: 05/24/2021
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LPA observed the first aid kit contained all required items including tweezers, thermometer, and scissors. LPA confirmed the facility has an active certificate of insurance for liability. Emergency drills are conducted quarterly.

LPA observed Covid-19 related posters throughout the facility including bathrooms. The facility has ample supply of PPE's, soap and sanitizer. All staff were wearing face masks and observed to be socially distancing.
LPA observed medication administration and storage. Medications are stored in a locked cabinet near the kitchen. Medications are being administered per physician order. The facility does several activities such as music therapy, board games, TV, outdoor sitting and activities, and exercises.
During the visit, LPA consulted with Licensee regarding the correct size of the PUB475 poster, and quarterly emergency drills. Facility will ensure emergency drills are conducted with different types of emergencies such as fire, earthquake and power shutoff.

Based on the observations made during the visit, no violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report was discussed and provided with Administrator Chand.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James AugustTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
LIC809 (FAS) - (06/04)
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