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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 07/28/2022
Date Signed: 08/15/2022 07:56:58 AM


Document Has Been Signed on 08/15/2022 07:56 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:SARAH CLEESENFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 90DATE:
07/28/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Allison Marty VP of Operations & Melanie Washington, Executive Director TIME COMPLETED:
02:00 PM
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This informal conference was conducted virtually via Team Meetings applications and was called to discuss the proof of corrections for a recent visit to the facility as well as concerns and deficiencies issued to the facility. At this informal conference present were: Regional Manager, Marina Stanic, Licensing Program Manager, Alisa Ortiz, Licensing Program Analyst, Kathrina Chin, Vice President of Operations, Allison Marty, Senior Vice President of Operations, Mike Zeug, Josh Allen, RN/Allen Flores Consulting Group, Executive Director, Melanie Washington, Director of LTCO Program, Libby Anderson, and Ombudsman, Nancy Bejarano.

The following was discussed:

· Facility lack of staffing impact on the facility plan of operation and assistance to residents with activities of daily living such as missed medications, absence of showers, missed laundry, dining and housekeeping.

The Licensee agreed to the following:

· Licensee will provide a Staffing Plan for the facility for two shifts such four caregivers and two medication technicians per shift and one shift (NOC) with two caregivers and one medication technician including all other pertinent staffing positions with a backup staffing plan by August 3, 2022.

· Licensee will provide an updated LIC 500 Personnel Report/Staffing Schedule biweekly to match approved staffing plan for the next 6 months.

· If additional residents are accepted, the facility will submit a new staffing plan reflecting the additional census.

· The Department will conduct additional visits to the facility for the next six months.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
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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