<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006090
Report Date: 02/19/2025
Date Signed: 02/19/2025 04:46:45 PM

Document Has Been Signed on 02/19/2025 04:46 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:SUNRISE GUEST HOME 1FACILITY NUMBER:
306006090
ADMINISTRATOR/
DIRECTOR:		OLTEANU, CLAUDIAFACILITY TYPE:
735
ADDRESS:323 E BLUEBELL PLACETELEPHONE:
(949) 232-9619
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Hayzel LangcauonTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 19th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual visit. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Hayzel Langcauon, and explained the nature of the visit. LPA Vanegas began a tour of the facility and observed the following.

This is a one storied home with four bedrooms, and two bathrooms one of which is a client bathroom and one of which is for staff and visitors bathroom, and a two car attached garage. LPA Vanegas observed kitchen area to be clean and free of mildew and debris. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non perishable food with a sufficient amount of emergency water. LPA Vanegas observed there to be a dishwasher that is not operational, and a technical advisory was issued advising to dispose of the non operational appliance. LPA Vanegas observed a microwave, and electric stove that tested to be operational and in good repair as well.

LPA Vanegas observed client bedrooms to be clean and in good repair. They consisted of all required furnishings such as a lamp, chair, bed, and clean linens in good repair, meaning no strains or tears. LPA Vanegas observed smoke detectors and carbon monoxide detectors to all be operational and in good repair. LPA Vanegas observed fire extinguisher to be up to date and fully charged. LPA Vanegas observed all required postings to be visible and accurate.

LPA Vanegas observed client bathroom to be clean and free of mildew and debris. Water faucets and toilet tested to be operational, and shower had all required furnishings such as grab bars, slip resistant matts, and a shower chair. Water tested from 103.4 degrees to 104.5 degrees.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SUNRISE GUEST HOME 1
FACILITY NUMBER: 306006090
VISIT DATE: 02/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Vanegas observed outside of the facility to be clean and free of any obstructions along the exit routes. There is an outdoor shaded sitting area, and backyard is big enough to participate in outdoor activities upon client request. LPA Vanegas reviewed P&I with house manager and all balances were accounted for and up to date.

LPA Vanegas observed all sharps, toxins, and medications to be locked away, and inaccessible to clients in care. LPA Vanegas reviewed medications with house manager and observed all centrally stored medications to be documented and to be given timely to clients in care. Per LPA Vanegas review all medications are being administered per physicians orders.

LPA Vanegas reviewed six client files, and four staff files. All files (Staff and Client) Consisted of the all the required documentation, and all training for staff was completed and up to date.

Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code Of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3