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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005628
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:05:00 PM


Document Has Been Signed on 12/13/2022 02:05 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:SUNNY CAREFACILITY NUMBER:
306005628
ADMINISTRATOR:PAO, WESLEYFACILITY TYPE:
740
ADDRESS:4662 SCHOOL STTELEPHONE:
(657) 363-8436
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 5DATE:
12/13/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Wesley PaoTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit for the deficiency cited on the LIC809D form issued on 10/28/2022. LPA was greeted and granted entry into the facility and stated the purpose of the visit. LPA met with Caregivers Denmark Martin, Fondador Pascua, and Bibina Linaza. Also present were Administrators Adriel Pao and Wesley Pao. LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today.

During today's visit, LPA conducted a health and safety check. No medications were observed in the residents' rooms. All medications were centrally stored and secured. The kitchen stove was replaced and the six burners were in operating condition.

*Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Licensee has complied with the POC.

LPA generated the Letter of Deficiency Citations Cleared and provided a copy to Administrator Wesley Pao. An exit interview was conducted with Administrator Wesley Pao, and a copy of this report was provided during this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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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