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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 08/13/2019
Date Signed: 08/13/2019 12:02:49 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:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:SHERRY FISCHERFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 117DATE:
08/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Micki CianciosiTIME COMPLETED:
12:10 PM
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This unannounced site visit was made by Licensing Program Analyst, Kathrina Chin for the purpose a case management - incident. LPA met with Micki Cianciosi, Interim Executive Director and Pat Colin, Business Office Director.

This is a follow up to an incident which occurred on August 9, 2019 at approximately 3 pm in which a fire broke out in Room 236 due to possibly a faulty cord. The facility sprinklers were set off and the fire alarm was set off. The fire department responded immediately and no injuries noted. Micki Cianciosi, ED, was at the facility and she reported that staff implemented their emergency procedures. The door was shut and evacuation procedures were started. Three itger resident rooms were impacted by the water flowing down from Room 236. All four residents were transferred to other rooms while their apartment are restored. The facility hired a restoration company, Bluesky, to address the water damage. Pat Colin stated that the Evacuation Chairs by the stairwell was utilized twice. She further mentioned that an in-service training on emergency procedures will be discussed on August 21, 2019.

No deficiency cited this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was given, Micki Cianciosi, Interim Executive Director.
SUPERVISOR'S NAME: Lori BertrandTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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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