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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005701
Report Date: 04/21/2025
Date Signed: 04/21/2025 09:43:05 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20250416151106
FACILITY NAME:SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTERFACILITY NUMBER:
306005701
ADMINISTRATOR:MICHAEL VILLARREALFACILITY TYPE:
772
ADDRESS:25481 GLORIOSA DRIVETELEPHONE:
(949) 533-3046
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
04/21/2025
UNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Andrew Crawford, Program DirectorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Facility did not ensure admission agreement was signed by client or authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a complaint investigation. LPA was greeted, granted entry and met with Andrew Crawford, Program Director (PD) and explained the purpose of the visit.

LPA and PD reviewed Admissions Agreement for Client #1 (C1). Admissions Agreement was signed by C1 upon admission on March 1, 2025 but the licensee had not signed the Admissions form. During a certification visit on March 24, 2025 a staff member signed the form. The date the form was signed was past the seven day requirement per Title 22 reguations.

Based on LPA record review and interview with PD Crawford, the preponderance of evidence standard has been met, therefore the allegation that the facility did not ensure admission agreement was signed by client or authorized representative is substantIated.
(Continued on LIC 9099-C)


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20250416151106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER
FACILITY NUMBER: 306005701
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
81068(d)
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81068(d) Admission Agreements d) Such agreements shall be dated and signed, acknowledging the contents of the document, by the client and the client's authorized representative and the licensee or the licensee's designated representative
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Facility staff signed the Admissions Agreement for Client #1 (C1) at time of certification visit on March 24, 2025.
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no later than seven calendar days following admission. This requirement is not met as evidenced by: Based on LPA record review one of one clients did not have a signed agreement by licensee which poses a potential health and safety risk to clients in care. ***This is an amended report***
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250416151106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER
FACILITY NUMBER: 306005701
VISIT DATE: 04/21/2025
NARRATIVE
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(Continued from 9099)

The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. The Plan of Correction (POC) was cleared on March 24, 2025 during certification visit.

An exit interview was conducted with Andrew Crawford, PD and a copy of this report was given to the facility along with a copy of the LIC 9099-D and Appeal Rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3