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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004564
Report Date: 11/04/2021
Date Signed: 11/04/2021 02:02:51 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 HUNTINGTON BEACHFACILITY NUMBER:
306004564
ADMINISTRATOR:MENSAH, ERICFACILITY TYPE:
740
ADDRESS:7401 & 7351 YORKTOWN AVETELEPHONE:
(714) 536-3032
CITY:HUNTINGTONSTATE: CAZIP CODE:
92648
CAPACITY:142CENSUS: 85DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Executive Director, Eric MensahTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility and temperature was checked at front desk. LPA explained reason for visit.

During the visit LPA toured the facility with Executive Director Eric Mensah. Facility is a two building,142 units facility. There are 85 Residents in care.There is a Assisted Living located in the first and second story of the main building, as well as a Reminiscence (Memory Care) wing attached on the both levels. LPA observed proper covid signage at front entrance of facility. At front receptionist desk there is a visitor check in. Facility has required Department postings. LPA toured Facility lobby, dining room, bistro, Reminiscence dining room, resident rooms, activities room, storage, wellness medication room and Terrace club. All Resident rooms observed where within department regulations. All restrooms observed contained soap, toilet paper, and paper towels. Residents were observed relaxing in the dining room eating lunch. Facility has operating smoke detectors and audible alarms which LPA observed Last fire inspection paperwork was completed on August 10,2021. Facility has several fire extinguishers, all which were observed as fully charged. Facility has ample supply of PPE. LPA observed facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPA observed 5 residents medications and facility has 30 days supply of medications for Residents. LPA reviewed Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has several designated visitation areas.

No deficiencies noted during todays visit. An exit interview was conducted with Executive Director Eric Mensah and a copy of report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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