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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005917
Report Date: 05/12/2026
Date Signed: 05/12/2026 12:12:26 PM

Document Has Been Signed on 05/12/2026 12:12 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNRAYS BOARD & CAREFACILITY NUMBER:
306005917
ADMINISTRATOR/
DIRECTOR:		RAYMOND TINIOFACILITY TYPE:
740
ADDRESS:7120 FILLMORE DR.TELEPHONE:
(714) 723-0169
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 4DATE:
05/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Raymond Tinio (Administrator) TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of completing an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giving staff. LPA explained the purpose of the visit and Administrator (AD) Raymond Tinio was notified via telephone, AD arrived shortly afterword in order to assist with the annual visit. LPA began a tour of the facility and observed the following. AD Raymond Tinio has a valid Administrator certificate valid from September 24,2024 through September 23, 2026.

The facility is a one storied home with a total of five bedrooms, four of which are resident rooms and one of which is for live in staff. The facility is equipped with two bathrooms, and an attached two car garage. LPA observed the kitchen area to be clean and free of mildew and debris. LPA observed a microwave, refrigerator, dishwasher, and a gas stove located in the kitchen area. All appeared to be in good repair and tested operational. LPA observed the facility to have a two day supply of perishable food and a seven day supply of non-perishable food. LPA observed all toxins and sharps to be locked away and inaccessible to residents in care.

LPA observed all resident rooms to be large enough to walk about freely, and be free of any obstructions, hazards, and toxins. LPA observed all resident rooms to have all required furnishings such as a chair, a lamp, a chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, and enough storage space to store personal belongings. LPA observed all resident restrooms to be clean and free of debris and mildew. LPA observed all water faucets and toilets to be operational. LPA observed restrooms to have all required furnishings such as grab bars, slip resistant floor matts, and a shower chair. Hot water temperature tested between 113.4 and 114.1 degrees Fahrenheit. CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SUNRAYS BOARD & CARE
FACILITY NUMBER: 306005917
VISIT DATE: 05/12/2026
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LPA observed all fire extinguishers to be fully charged and have an updated service tag attached to it. LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed first aid kit to have all required items such as scissors, tweezers, adhesive tape, bandages a thermometer, and a first aid manual.

LPA conducted a tour of the outside of the facility, and observed the following. LPA observed the backyard to be large enough to participate in outdoor activities upon resident request. LPA observed an outdoor shaded sitting area, and for the backyard to be free of any debris and large obstructions blocking the exit routes. The side doors were observed to be self latching an unlocked.

LPA reviewed two staff files and four resident files. All resident files had all required documents. Staff training was not up to date and documented correctly a deficiency was issued on today's date. LPA reviewed medications with AD and per LPA review all medications are being documented correctly and being administered per physicians orders. Based on today's observations deficiencies will be issued per title 22 chapter 6 division 8 of the California Code of Regulations. An exit interview was conducted with AD and a copy of this report was provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/12/2026 12:12 PM - It Cannot Be Edited


Created By: William Vanegas On 05/12/2026 at 11:53 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUNRAYS BOARD & CARE
FACILITY NUMBER: 306005917

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(1)
Other Provisions
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of three staff not having updated annual training which poses a potential health and safety risk to persons in care.
POC Due Date: 05/26/2026
Plan of Correction
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Administrator agrees to train staff and document it correctly. Administrator will send proof of correction to LPA prior to P.O.C due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM MANAGER:
William Vanegas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2026


LIC809 (FAS) - (06/04)
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