306003502-7-19-2022-22-AS-ETAA-CGGS5Q-20220719133444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003502
Report Date: 07/19/2022
Date Signed: 07/19/2022 01:34:53 PM

Document Has Been Signed on 07/19/2022 01:34 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:	SUNNY CREST GUEST HOME #3		FACILITY NUMBER:	306003502
ADMINISTRATOR:	KENNETH/MARIA HUNTER		FACILITY TYPE:	740
ADDRESS:	5174 FOX HILLS		TELEPHONE:	(714) 562-1082
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY:	6	CENSUS: 5	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Kenneth Hunter, Carmen Lingat		TIME COMPLETED:	01:50 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) Edward Tapia made an unannounced required annual inspection in this facility. LPA met with staff Carmen Lingat and Administrator Kenneth Hunter stated the purpose of this visit. The facility is a single level structure and licensed for six non-ambulatory residents. This facility is a Residential Care Facility for the Elderly. At about 11:35 AM, LPA Tapia was granted entry but was not asked to complete the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed five residents in care and one staff member and Administrator on duty. LPA toured the interior and exterior portions of the facility. There were three resident rooms and one staff room. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 116.7 degrees Fahrenheit. LPA noticed that a light bulb needed to be replaced. Bathroom (2) was observed to be in good repair and provided with grab bars and hot water was measured at 118.7 degrees Fahrenheit. LPA noticed handwashing signs were not posted in the restrooms and informed Administrator. LPA also noticed the PUB 475 See Something, Say Something sign was not the required size 20x26 inches. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to residents in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA did notice gardening tools to be out in the open and a hose untangled. Administrator immediately removed them so residents could not access them. The exterior portion of the facility also contained several fruit trees which were maintained.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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: SUNNY CREST GUEST HOME #3	FACILITY NUMBER: 306003502
	VISIT DATE: 07/19/2022

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Garage is kept locked and used for storage. Laundry room was in good repair. Kitchen was in good repair with medications kept locked. LPA did notice scissors unlocked in the kitchen and Administrator removed them immediately. LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency disaster plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. Three advisories were issued today.

LPA Tapia conducted an exit interview with Administrator Kenneth Hunter and copy of this report was explained and left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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