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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005651
Report Date: 10/28/2022
Date Signed: 10/28/2022 03:26:25 PM


Document Has Been Signed on 10/28/2022 03:26 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:SUNRISE GARDENFACILITY NUMBER:
306005651
ADMINISTRATOR:PARDEDE, FERDINANDFACILITY TYPE:
740
ADDRESS:29751 ANA MARIA LANETELEPHONE:
(949) 423-6175
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 5DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Cherry Alfonso TIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Administrator Ferdinand Pardede's Administrator's certificate expires 5/19/2023. Facility is a single story home with 7 bedrooms (1 is for staff), 5 bathrooms, living room, dining room, kitchen and a 2 car garage. The living room and dining room both have screened fireplaces. Hot water measured 120.2 degrees Fahrenheit. The hot water temperature was adjusted during the visit. All resident bathrooms were clean and operational. LPA observed all resident bedrooms were clean, organized and had the required furnishings. Smoke detectors/carbon monoxide detectors tested operational. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the stove lights unassisted, Medication is kept locked in a kitchen cabinet. Knives and sharp objects are kept locked in a kitchen drawer, The garage is kept locked and used for storage. The fire extinguisher in the kitchen and the fire extinguisher in the hallway are both fully charged. LPA and staff toured the backyard. No bodies of water observed. Both exit gates are operational. The patio has a table and chairs to sit outside. There is a fountain in the corner of the backyard but it is empty. No obstacles or hazards observed. LPA consulted with staff concerning continued Covid-19 mitigation procedures and reporting requirements. No deficiencies are being cited as a result of this visit, An exit interview was conducted and a copy of the report was provided,
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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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