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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004562
Report Date: 10/12/2020
Date Signed: 10/12/2020 03:20:33 PM

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 SEAL BEACHFACILITY NUMBER:
306004562
ADMINISTRATOR:LUIS RODRIGUEZFACILITY TYPE:
740
ADDRESS:3850 & 3840 LAMPSON AVETELEPHONE:
(562) 594-5788
CITY:SEAL BEACHSTATE: CAZIP CODE:
90740
CAPACITY:261CENSUS: 148DATE:
10/12/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Luis Rodriguez, AdministratorTIME COMPLETED:
03:19 PM
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz contacted the facility for the purpose to
to conduct a case management visit to deliver an amended report for a visit conducted on 10/07/2020 regarding Complaint Control #: 22-AS-20200205161415.

Today's tele-visit was conducted via telephone due to COVID-19 and pre-cautionary measures.

The initial report was delivered on 10/07/2020. LPA Quiroz reviewed the amended report with Administrator Luis Rodriguez, and addressed any concerns and/or questions regarding the amendment of the report. Administrator Luis Rodriguez did not have any concerns or questions.


An exit interview was conducted with Administrator Luis Rodriguez, and a copy of this report along with the amended complaint report (LIC 9099 A) was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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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