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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004563
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:57:10 PM


Document Has Been Signed on 09/29/2022 01:57 PM - 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 ASSISTED LIVING AT LA PALMAFACILITY NUMBER:
306004563
ADMINISTRATOR:MUNOZ, JENNIFERFACILITY TYPE:
740
ADDRESS:5321 LA PALMA AVETELEPHONE:
(714) 739-8111
CITY:LA PALMASTATE: CAZIP CODE:
90623
CAPACITY:80CENSUS: 70DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jennifer MunozTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced required annual inspection. LPA arrived at facility was greeted by receptionist and checked in via covid screening process. LPA met with Jennifer Munoz, Administrator and explained the nature of the visit.

Upon entry LPA observed the screening/sanitizing station at the entrance of the facility. Visitors sing in and are screened for temperature. Facility does temperature check on a daily basis in the facility and document the results. LPA observed facility to have covid precautionary postings as well all required department postings. LPA accompanied by Jennifer Munoz, Administrator began the tour of the inside and outside of the facility. During the tour all areas of the facility related to resident’s care were toured including all common areas. All restrooms observed to have ample supply of soap and appeared to be clean. LPA inspected residents’ bedrooms and appeared to be clean and sanitary. Bedrooms observed to have all required components. Facility fire clearance is maintained in conformity with State Fire Marshall regulations; Fire extinguishers were mounted and charged, Smoke detectors and Carbon monoxide detectors meet the regulatory requirements. All disinfectants, cleaning solutions, and poisons were inaccessible to residents and stored in locked storage room. LPA toured the kitchen and observed appliances to be in operational condition. LPA observed facility to have a supply of emergency food and water in the facility. The facility was noted to be clean, safe, and sanitary. Facility has an ample supply of PPE in the storage unit. LPA toured the outside of the facility and observed a several shaded seating areas for resident’s enjoyment.

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



This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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