306002644-7-3-2023-22-AS-SHAD-CTDQAN-20230703120012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002644
Report Date: 07/03/2023
Date Signed: 07/03/2023 12:00:16 PM

Document Has Been Signed on 07/03/2023 12:00 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:	SUNRISE OF MISSION VIEJO		FACILITY NUMBER:	306002644
ADMINISTRATOR:	PSENECNIK, ROXANNE		FACILITY TYPE:	740
ADDRESS:	26151 COUNTRY CLUB DRIVE		TELEPHONE:	(949) 582-2010
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	110	CENSUS: 88	DATE:	07/03/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Maria Domingo		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	This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on construction plans for renovating the kitchen floor submitted to the Orange County Regional Office (OCRO) on 06/27/23. LPA met with Administrator (AD) Maria Domingo and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility, reviewed the facility’s construction plans, and discussed the plans. There is one kitchen at the facility and two bistros. All cooking is done in the kitchen while the bistros are used for serving. Prior to construction, the facility will have a mobile kitchen delivered to the back parking lot. The estimated date for the mobile kitchen being deployed is August. Once the mobile kitchen is deployed, the kitchen will be closed and the construction will take place. The construction will be focused on replacing the kitchen’s floor and replacing a few pieces of equipment. During construction, food will be cooked in the mobile kitchen and will enter the facility in large holding cabinets through the back door of the memory care unit. Food that is meant for the memory care will be served from the memory care bistro. Food that is meant for assisted living will be served from the assisted living bistro and will exit the memory care unit via the elevator. Staff delivering the food will ensure delayed egress alarms are re-armed at each door during transport. In addition, the memory care residents will be seated at the dining room and supervised by multiple staff during the food transport. The entire meal for each unit can fit on a single holding cabinet, so only one of the two cabinets will exit the memory care. This is similar to how a holding cabinet is currently used to bring food into the memory care. AD estimates the entire construction project will take less than two weeks after which point the mobile kitchen will be removed. During construction, the facility’s kitchen will be closed and locked and residents will not have access to it. Knives and cooking equipment will be locked in the mobile kitchen. The storage of cleaning supplies will not be affected by this project. Food will be stored in storage pods next to the mobile kitchen, which includes refrigerators and freezers.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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: SUNRISE OF MISSION VIEJO	FACILITY NUMBER: 306002644
	VISIT DATE: 07/03/2023

NARRATIVE

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The construction crew will be managed by their manager and foreman. AD and the facility’s maintenance coordinator will meet with the manager and foreman weekly for updates. The protocol will be that the construction crew and their tools remain in the kitchen during construction and that the kitchen be locked to residents. There is a back door for the construction crew to enter and leave the kitchen without entering other parts of the facility or interacting with residents.

During the inspection, LPA inspected the kitchen, bistros, parking lot, and travel pathways to be used during the construction. LPA advised AD to notify LPA once the construction has been completed.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC809 (FAS) - (06/04)

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