306004562-9-27-2022-22-AS-RQUZ-CJNPPT-20220927113003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004562
Report Date: 09/27/2022
Date Signed: 09/27/2022 11:30:17 AM

Document Has Been Signed on 09/27/2022 11:30 AM - 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 SEAL BEACH		FACILITY NUMBER:	306004562
ADMINISTRATOR:	LUIS RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	3850 & 3840 LAMPSON AVE		TELEPHONE:	(562) 594-5788
CITY:	SEAL BEACH	STATE: CA	ZIP CODE:	90740
CAPACITY:	261	CENSUS: 118	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sandra Robles, Business Office Coordinator, Marlen Arguero,Associate Executive Director		TIME COMPLETED:	11:35 AM

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On today’s date, Licensing Program Analysts(LPAs) LPA Rosie Quiroz and LPA Alvaro Ramirez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPAs were greeted, Covid-19 screened and granted entry into the facility by Front desk Receptionist and met with Sandra Robles, Business Office Coordinator (BOC) and explained the nature of the visit. Marlen Arguero, Associate Executive Director (AED) arrived shortly after. Interim Executive Director (IED) Thais Souza unable to attend today's inspection visit due to attending a leadership conference out of state.

This facility is licensed to provide services to 210 Non Ambulatory, 51 Ambulatory, has a hospice waiver for 20 residents and includes a dementia unit with delayed egress. Facility is currently providing hospice services to eleven (11) residents.

(IED) Thais Souza has an Administrator Certificate with expiration date of 9/10/2022. (IED) Souza completed Administrator certification renewal, awaiting new certificate. Facility will provide new Administrator Certificate to Community Care Licensing upon receiving it.

On or about 9:22am, LPAs along with (AED) Marlen Arguero and Wendy Wheeler, Director of Sales (DOS) toured the interior facility, kitchen area and exterior facility premises. All staff working at facility were observed to be wearing face masks upon arrival to facility. There are 118 residents in care and there are no active resident COVID-19 cases , and two active COVID-19 staff cases. During today's inspection visit, LPAs observed residents participating in Activities in Building A, on the Reminiscence Memory unit and other residents were observed to be resting in their bedrooms watching television. Residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary with all required components.

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SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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: SUNRISE OF SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 09/27/2022

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During today's visit, LPAs reviewed resident files for Resident (R) R1-R5. Water temperatures were recorded to be between 105.4 degrees Fahrenheit-108.6 degrees Fahrenheit. Facility indoor temperature was recorded to be between 75-77 degrees throughout the facility.

LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily three times per day and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as ample PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for residents and visitors enjoyment. Facility has completed the LIC 808 Mitigation plan dated 1/15/2021, which was approved on 10/19/2021. Facility has submitted and infection control plan. Facility indicated to be partnering up with CVS pharmacy and holding a flu vaccine and COVID-19 clinic on October 20, 2022 for residents and staff.

During today's visit, LPAs provided (AED) Arguero with Infection Control and Title 22 consultation.

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

This report was reviewed with (AED) Marlen Arguero, and a copy of this report, LIC 811- Confidential Names were provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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