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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:49:46 PM


Document Has Been Signed on 08/03/2022 01:49 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:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:SARAH CLEESENFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 85DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Melanie Washington - Executive DirectorTIME COMPLETED:
01:42 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced Case Management visit to Sunnycrest Senior Living. LPA Velazquez was allowed entry into the facility and met with Executive Director (ED) Melanie Washington. This Case Management visit was conducted in conjunction with 2 complaint visits with complaint control numbers: 22-AS-20220727153122 and 22-AS-20220728130902. The purpose of this Case Management visit was to inform ED Washington of the facility's overdue annual fees. LPA Velazquez provided ED Washington with a copy of the Facility Transaction History which includes a PIN Number to facilitate paying the annual fees online. Facility fees are to be paid by August 5, 2022 with proof of payment to be submitted to LPA Velazquez.



There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Executive Director Melanie Washington and a copy of this report was provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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