306002636-6-4-2024-22-AS-MTEA-D5WQBH-20240604120134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002636
Report Date: 06/04/2024
Date Signed: 06/04/2024 12:02:04 PM

Document Has Been Signed on 06/04/2024 12:02 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:	SUNFLOWER LIVING		FACILITY NUMBER:	306002636
ADMINISTRATOR:	SUNITA CHAND		FACILITY TYPE:	740
ADDRESS:	9282 BLANCHE AVENUE		TELEPHONE:	(714) 534-7872
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 5	DATE:	06/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Sunita Chand		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:30 AM, LPA Tea was greeted and granted entry into the facility by caregiver, Varinder Singh and Sonia Caceres and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for six. Currently there are five residents, of which three are on hospice during today's visit. The Administrator, Sunita Chand arrived shortly after to assist during the visit. At 8:52 AM, LPA Tea reviewed five resident files and three staff files. Residents files and staff files contained all required documentation. Administrator certificate expires on June 15, 2025. LPA Tea along with the Administrator toured the facility at 9:41 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, which one is shared, 1 staff bedroom, 2 full bathrooms and 2 half bathrooms, living room, dining room, and kitchen. At 9:48 AM LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. 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 114.4 F degrees and 116.6 degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. There are cameras placed in the common areas of the facility without audio for the safety of residents in care. First aid kit had all the required elements including tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink. Annual report continued on LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNFLOWER LIVING	FACILITY NUMBER: 306002636
	VISIT DATE: 06/04/2024

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Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and the exit gate is self latching and operational. The backyard has a small garden area, where residents can garden if they wanted to. LPA observed emergency food and water supply in the garage. Facility provides activities in the form of outdoor activities such as going out for walks and doing exercises. The residents play chess and card games as well.

At 10:03 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with administrator, Sunita Chand and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102 was read and provided through email to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

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