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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 02/27/2024
Date Signed: 02/27/2024 10:36:22 AM


Document Has Been Signed on 02/27/2024 10:36 AM - 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:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:AGUIRRE, MONICAFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 92DATE:
02/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Melanie Washington, Executive DirectorTIME COMPLETED:
10:40 PM
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced case management visit for the purpose of issuing a civil penalty concluded during investigation of complaint control #22-AS-20230817163330 completed by the department. LPA Quiroz was greeted and granted entry into the facility by front desk receptionist and met with Melanie Washington, Executive Director and explained the reason for the visit.

Civil penalty assessed on today's date. (SEE LIC 421IM)



An exit interview was conducted with (ED) Melanie Washington and was provided with copy of report, Appeal rights and Civil penalty assessment- LIC 421IM.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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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