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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002644
Report Date: 09/06/2023
Date Signed: 09/06/2023 12:46:14 PM


Document Has Been Signed on 09/06/2023 12:46 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 VIEJOFACILITY NUMBER:
306002644
ADMINISTRATOR:MARIA T. DOMINGOFACILITY TYPE:
740
ADDRESS:26151 COUNTRY CLUB DRIVETELEPHONE:
(949) 582-2010
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:110CENSUS: 85DATE:
09/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Maria DomingoTIME COMPLETED:
01:00 PM
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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 first inspection on 07/03/23, LPA inspected the facility and reviewed the facility’s plans for the kitchen floor renovation. Per AD, the kitchen floor renovation project was completed on 08/11/23, there were no issues related to the project, and the facility returned to normal kitchen operations.

During today’s inspection, LPA and AD toured the kitchen. LPA observed the floors were replaced as part of the kitchen floor renovation project and the kitchen contains all necessary fixtures, tables, appliances, and equipment. LPA observed the kitchen to be clean and organized and observed no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. LPA observed lunch was being served with residents eating in the dining room. LPA confirmed the kitchen floor renovation project has been completed without issue.


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 LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
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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