<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005153
Report Date: 04/04/2022
Date Signed: 04/04/2022 03:48:06 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/04/2022 03:48 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:SUNNY DAYS HOME CARE 1FACILITY NUMBER:
306005153
ADMINISTRATOR:HAN, CLARA JEESUKFACILITY TYPE:
740
ADDRESS:9448 KIWI CIRCLETELEPHONE:
(714) 968-4909
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 5DATE:
04/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Adel Catapang, Live in Caregiver and Clara Han, Licensee/AdministratorTIME COMPLETED:
03:59 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 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 Rosie Quiroz was greeted, COVID-19 screened and granted entry into the facility by caregiver Adel Catapang. LPA Rosie Quiroz explained the nature of the visit to Caregiver Adel Catapang. Licensee/Administrator (L/AD) Clara Han arrived shortly after to the facility.
On or about 2:20pm, LPA Rosie Quiroz along with Caregiver Adel Catapang began the tour of the inside and outside of the facility. There are five residents in care and there are no active Covid-19 cases in the facility. LPA Quiroz observed three of five residents in dining room area eating lunch, and observed two of five residents eating lunch in their bedrooms. During today's visit, LPA Quiroz interacted with residents in care. 5 of 5 residents appeared to be clean and well taken care of. LPA Quiroz observed a check in station in the entry of the facility where incoming visitors are being screened per COVID-19 protocol. LPA Quiroz observed required department postings, Covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. All restrooms observed to have a supply of soap and appeared to be clean. LPA Quiroz inspected resident’s bedrooms and appeared to be clean. All bedrooms observed to have all required components. LPA Quiroz observed the emergency and disaster and evacuation plan located in kitchen area. Facility has a supply of emergency food and water in kitchen area. LPA Quiroz observed the PPE supply in the facility readily available for use. LPA Quiroz toured the outside of the facility and observed seating are with shaded area for residents and visitors enjoyment. The facility has completed the LIC 808 Mitigation Plan dated 12/31/2020; however no copy saved on file. L/AD Han agreed to submit LIC 808 to LPA Quiroz by COB to be uploaded. At this time, LPA Quiroz reviewed LIC 808, and approved plan. LPA Quiroz was informed that all residents and staff have had their COVID-19 vaccinations and boosters. During today's visit, LPA Quiroz submitted PPE request for facility to Orange County Regional Office.
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 L/AD Clara Han, and a copy of this report and LIC 811 were provided via email.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1