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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 06/19/2024
Date Signed: 06/19/2024 05:12:12 PM


Document Has Been Signed on 06/19/2024 05:12 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
ORANGE COUNTY RO, 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: 91DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Melanie Washington, Executive DirectorTIME COMPLETED:
05:00 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Executive Director Melanie Washington was notified and assisted with the visit.

LPA reviewed the facility's resident census, staff roster, Emergency and Disaster Plan, Infection Control Plan, staff schedules. A sample of ten staff records and ten resident records were reviewed during the visit. Background clearance and association to the facility was verified for all 39 staff members on the roster. Sufficient staffing levels were observed throughout the facility as well as in the kitchen.

The facility is a two-story building arranged around a central courtyard which is currently undergoing renovations. LPA conducted a tour of the interior and exterior of the physical plant. Rooms reviewed were provided with furniture in good repair, clean linens, adequate storage space, and kept free of obstructions. Smoke, carbon monoxide, and facility call system were operational. Bathrooms were observed to be in good repair, with non-skid strips. However some bathrooms observed had no grab bars on the inside of the shower itself. Hot water was measured within acceptable range in four separate bathrooms throughout the physical plant.
Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to residents in care. LPA reviewed the facility's two medication carts during the medication round in the dining room. Fire extinguishers were mounted and charged. For the exterior portion, facility has several patio furniture sets with umbrellas for shade and the grounds and routes of egress were free of tripping hazards.
Based on the observations made during today's visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Two Technical Violation Advisory Notes were provided. An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024
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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