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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004564
Report Date: 10/03/2022
Date Signed: 10/03/2022 12:23:30 PM


Document Has Been Signed on 10/03/2022 12:23 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 OF HUNTINGTON BEACHFACILITY NUMBER:
306004564
ADMINISTRATOR:MENSAH, ERICFACILITY TYPE:
740
ADDRESS:7401 & 7351 YORKTOWN AVETELEPHONE:
(714) 536-3032
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:142CENSUS: 86DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Executive Director, Janelle OdishooTIME COMPLETED:
12:45 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 met with Executive Director Janelle Odishoo. Facility is a two building,142 units facility. There are 86 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 Tirre toured facility with Executive Director Odishoo and Maintenance Coordinator John Carramanzana. LPA observed proper covid signage at front entrance of facility. Upon entering facility there is a receptionist desk where visitor's can check in and have temperature scanned. Facility has required Department postings. Emergency Disaster Plan is easily accessible in binder located near entrance.

LPA toured Facility lobby, dining room, bistro, Assisted Living, Reminiscence wing, 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 working wash basin, soap, toilet paper, and paper towels. Common area restrooms had proper hand washing signs posted.

Residents were observed relaxing in common areas reading, exercising in Memory care, and singing inside Terrace club. Facility has operating smoke detectors, audible alarms, and sprinkler system which LPA observed Last inspection paperwork by Johnson Controls and updated as of 7/6/22. Facility has several fire extinguishers, all which were observed as fully charged and updated by Fire Master Annual Service documented on 9/19/22. LPA observed Facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPA observed 5 resident medication files, facility has 30 days supply of medications for Residents. LPA reviewed Residents files during visit. CONTINUED ON LIC 809C
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 BEACH
FACILITY NUMBER: 306004564
VISIT DATE: 10/03/2022
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LPA observed 5 resident files and residents emergency contact information and Physicians reports are current. Facility has ample PPE supply. Facility has several designated visitation areas. All staff were observed wearing masks.

No deficiencies noted during todays visit. An exit interview was conducted with Executive Director Janelle Odishoo 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: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
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