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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004754
Report Date: 02/26/2021
Date Signed: 02/26/2021 05:20:36 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:SUNFLOWER GARDENSFACILITY NUMBER:
306004754
ADMINISTRATOR:SANDRA ACOSTA-LOUERFACILITY TYPE:
740
ADDRESS:3730 S. GREENVILLE AVENUETELEPHONE:
(714) 641-0959
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:72CENSUS: 43DATE:
02/26/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:SANDRA ACOSTA-LOUERTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Sean Haddad conducted an unannounced Case Management inspection for the purpose of a health and safety check. LPA arrived at the facility on 2/26/21 at 3:45 PM and was greeted and granted entry by the receptionist. LPA met with Administrator (AD) SANDRA ACOSTA-LOUER, explained the reason for today's inspection, and conducted a tour of the facility, common areas, resident rooms, and kitchen along with AD, observed residents and staff, and requested and obtained resident records, staff records, resident roster, and staff roster.

During today's inspection, LPA inspected the main common area and residential wings and observed there were 7 care staff present and 2 med techs, all wearing PPE. LPA observed 31 residents present in the common area and additional residents in their rooms, all doing well with no health or safety issues noted. LPA inspected common areas, resident rooms, and kitchen, and observed they were clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishable food and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 of the California Code of Regulations.

An exit interview was conducted and a copy of this report was discussed with and provided to AD.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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