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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306004562
Report Date:
02/04/2021
Date Signed:
02/04/2021 02:20:47 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 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:
DATE:
02/04/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Luis Rodriguez
TIME COMPLETED:
01:15 PM
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Licensing Program Manager (LPM) Valarie Cook and Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit in conjunction with Adult Protective Services (APS) Senior Social Worker (SSW) Andrea Simon to check on the health and welfare of a resident. LPM Cook and LPA Alejandre and SSW Simon met with Executive Director Luis Rodriguez. LPM and LPA interviewed residents. LPM interviewed Executive Director.
No deficiencies were observed at this time. An exit interviewed was conducted and a copy of this report was provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/04/2021
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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