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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004562
Report Date: 01/27/2021
Date Signed: 01/27/2021 03:06:27 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: 121DATE:
01/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Luis RodriguezTIME COMPLETED:
03:26 PM
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Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to the facility. LPM and LPA were let into the facility and screened for symptoms and temperature by staff prior to being granted access to the facility. LPM and LPA were greeted by Executive Director (ED) Luis Rodriguez. LPM and LPA visited the facility in regards to a self reported concern regarding the health and care of a resident. LPM and LPA interviewed the ED concerning the health and welfare of residents. LPM and LPA interviewed Resident 1(R1) and Resident 2 (R2). LPM provided resident with contact information. LPM and LPA interviewed multiple staff and spoke with ED Rodriguez.

LPM and LPA advised all parties that the facility is required to follow Title 22 California Code of Regulations including but not limited to contacting emergency services to protect the safety of all residents as needed and to enter the room to provide services to the residents including cleaning, assistance with medication and hygiene as needed and agreed upon in Admission Agreements. In addition, Prescription medication is to be stored locked and inaccessible to those residents who are not authorized to administer their own medications.

ED Rodriguez acknowledged the facility staff will continue to care for and provide assistance to residents and seek medical assistance when required.

Health and safety check was conducted. Both residents were well groomed and dressed. Facility temperature was comfortable and within regulatory requirements. The facility has water and electricity.

At this time no violations are being cited. An exit interview was conducted and a copy of this report was provided to ED Rodriguez.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
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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