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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004562
Report Date: 10/19/2021
Date Signed: 10/19/2021 02:05:30 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: 140DATE:
10/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Luis Rodriguez, Executive Director and Tiffany Tadros, Assisted Living CoordinatorTIME COMPLETED:
02:05 PM
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On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted, screened and granted entry into the facility by Front desk Receptionist and met with Executive Director (ED) ED Luis Rodriguez, and explained the nature of the visit. 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.

ED Luis Rodriguez has an Administrator Certificate with expiration date of 10/26/2023 .

On or about 12:33pm LPA Quiroz along with ED Rodriguez toured the facility. All staff working at facility were observed to be wearing face masks upon arrival to facility. There are 140 residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed residents eating lunch in dining room. 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. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily 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 resident’s enjoyment. Facility has completed the LIC 808 Mitigation plan dated 1/15/2021, which was approved on today's date.

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 ED Luis Rodriguez, and a copy of this report was provided to ED Rodriguez at exit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
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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