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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005701
Report Date: 03/28/2022
Date Signed: 03/28/2022 01:04:07 PM

Document Has Been Signed on 03/28/2022 01:04 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: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: 2DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Clinical Director, Melissa Wright and Operations Manager, Chad ChapmanTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility by Staff and explained the reason for the visit.

During the visit LPA toured the facility with Operations Manager Chad Chapman and reviewed client information with Clinical Director Melissa Wright. Facility is a 3 bedroom and 3 bathrooms two story home. There are 2 Clients in care. LPA observed Department postings. LPA toured all Clients rooms, rooms where within regulations. All restrooms observed contained working water basin, soap, toilet paper, and hand towels. Hand washing signs were posted in restrooms. Clients were observed relaxing in the Living rooms watching TV and eating meal in kitchen. Facility has 1 fire extinguisher which is fully charged and mounted. Facility has supply of PPE. Facility has refrigerator and pantry with ample food supply. LPA observed facility has emergency food and water supply. Facility has Evacuation Plan and Personal Rights posted. Facility has a secured location for client medication and files. Facility has 30 days supply of medications for clients. LPA reviewed clients files during visit. Clients emergency contact information and Physicians reports are current.

No deficiencies noted during today's visit. An exit interview was conducted with Clinical Director and a copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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