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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005738
Report Date: 04/08/2022
Date Signed: 04/08/2022 03:23:54 PM

Document Has Been Signed on 04/08/2022 03:23 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:SUNFLOWER HOMEFACILITY NUMBER:
306005738
ADMINISTRATOR:WHITE, DAVID E.FACILITY TYPE:
735
ADDRESS:1161 ORLANDO STTELEPHONE:
(949) 612-9883
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 4CENSUS: 0DATE:
04/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Ruth Hunter- mother of administrator TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA toured facility with Ruth Hunter, mother of administrator.

LPA Mendivil toured the 2 story, 3 bedroom, 2 bathroom facility with an attached garage. LPA Mendivil called Administrator David White during the tour and was notified no clients are currently in care. LPA Mendivil observed personal belongings of mother of administrator and family friend who currently resides in the home. R3 has belongings of previous client (C1) as they are in transition of moving all belongings to their current residence.

During phone call with Administrator David White, administrator was notified to advise department prior to accepting new clients into the facility.

No deficiencies noted during todays visit. An exit interview was conducted and a copy of this report was left at the facility,
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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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