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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005424
Report Date: 08/13/2021
Date Signed: 08/13/2021 02:18:30 PM

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:SUNRISE VILLA BRADFORDFACILITY NUMBER:
306005424
ADMINISTRATOR:CALABRESE, RUZICAFACILITY TYPE:
740
ADDRESS:1180 & 1176 N BRADFORD AVETELEPHONE:
(714) 996-9292
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:136CENSUS: 78DATE:
08/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ruzica CalabreseTIME COMPLETED:
02:30 PM
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Licensing Program Analyst Michelle Reed arrived at the facility to conduct a case management. The visit was unannounced and was conducted to discuss a self reported incident that occurred at the facility on 7/24/21. Upon arrival, LPA met with Administrator Ruzica Calabrese.

On 7/23/21 at approximately 9:30pm, R1, who resides in the Terrace Club, reported to care staff that S1 insisted that R1 go to the restroom in R1's diaper. R1 wanted to use the toilet. When R1 refused, S1 "stomped" on R1's foot.

S1 stated that R1 tried to hit S1 and when S1 backed up S1 accidentally stepped on R1's foot. R1's right foot was swollen and had started to bruise. Xrays were taken on 1/27/21 of R1's foot and there were no fractures.

S1 was interviewed on 7/23/21 immediately after the incident and was suspended. As of 7/30/21, S1 no longer works for Sunrise.

No deficiencies issued at this time.

An exit interview was conducted and a copy of this report was provided to Administrator Ruzica Calabrese.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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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