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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 05/27/2025
Date Signed: 05/27/2025 05:21:20 PM

Document Has Been Signed on 05/27/2025 05:21 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/
DIRECTOR:		AGUIRRE, MONICAFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 210TOTAL ENROLLED CHILDREN: 0CENSUS: 115DATE:
05/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator - Monica AguirreTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On May 27, 2025 at 8:00am, Licensing Program Analysts (LPASs) Eboni Bentley and Jenifer Tirre made an unannounced visit to the facility for the purpose of conducting an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPAs were greeted and granted entry by Dining Services Manager, Sergio Mendoza and stating the purpose of the visit. Administrator/Executive Director (AD), Melanie Washington was notified and assisted with the visit.

LPAs 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 staff members on the roster.
Emergency safety drills was last conducted on March 10, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were inspections were reviewed and observed operational. The facility has several fire extinguishers that were charged throughout the facility, all last serviced on or around August 7, 2024. Liability Insurance is effective December 23, 2024 through December 23, 2025.

The facility is a two-story building arranged around a central courtyard. LPAs 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. Bathrooms were observed to be in good repair, with non-skid strips and grab bars on the inside of the shower. Hot water was measured between 125.4 and 130.2 F in three out of ten separate bathrooms throughout the physical plant.

CONTINUE TO LIC809-C PAGE
Lourdes MontoyaTELEPHONE: (714) -705-6014
Eboni BentleyTELEPHONE: 714-552-7883
DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/27/2025 05:21 PM - It Cannot Be Edited


Created By: Eboni Bentley On 05/27/2025 at 04:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNYCREST SENIOR LIVING
FACILITY NUMBER: 306005223

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, hot water temperatures in three out of ten rooms measured between 125.4 F and 130.2 f., which poses an immediate health and safety risk to residents in care. LPAs observed these temperatures above regulation in rooms 263, 276 and 126.
POC Due Date: 05/28/2025
Plan of Correction
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Licensee stated they will submit water temperature logs for temperatures checked in all three rooms by 5pm on POC due date. Licensee will send proof to CCLD via email to LPA.
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on oberservation and interview, the licensee did not comply with the section cited above in two out of ten resident
medications, which poses an immediate health and safety risk to persons in care. LPA observed one or more medication unlocked in residents room and one medication ointment cannot be located by staff. The resident has a Dementia diagnosis.
POC Due Date: 05/28/2025
Plan of Correction
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Licensee will review all resident medications and locate missing medication for Resident #1. Licensee will send picture of medication to CCLD via email by POC due date. LPA observed staff remove multiple medications from resident room and relocate to locked medication room.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (714) -705-6014
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: 714-552-7883
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 LIVING
FACILITY NUMBER: 306005223
VISIT DATE: 05/27/2025
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Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Cleaning supplies and sharp items were inaccessible to residents in care. LPAs reviewed the five resident medications records and found one resident, Resident #1 (R1) missing a medication that staff could not locate and an addition medication for R1 found in resident’s room.

Based on the observations made during today's visit, two Type A deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report with appeal rights was provided to Administrator/Executive Director Melanie Washington.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -705-6014
LICENSING EVALUATOR NAME: Eboni BentleyTELEPHONE: 714-552-7883
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025
LIC809 (FAS) - (06/04)
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