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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006093
Report Date: 04/26/2024
Date Signed: 04/26/2024 04:49:02 PM

Document Has Been Signed on 04/26/2024 04:49 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 3FACILITY NUMBER:
306006093
ADMINISTRATOR/
DIRECTOR:
OLTEANU, CLAUDIAFACILITY TYPE:
735
ADDRESS:2000 CALLE CANDELATELEPHONE:
(949) 232-9619
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 6DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Claudia OlteanuTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On April 26, 2024 at 2:45pm, Licensing Program Analyst (LPA) Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Direct Support Professional (DSP) Keylan Meneses. A phone call was made to Administrator (AD) Claudia Olteanu, where she arrived around 4:00pm and joined the visit. LPA Kim explained the purpose of the visit.

The facility is licensed to operate for three (3) ambulatory clients and three (3) non-ambulatory of which one (1) may be bedridden. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) client bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, and outside covered patio area.

LPA Kim toured inside and outside of the physical plant with DSP Meneses. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Client’s rooms were inspected: Client Room 1, Client Room 2, Client Room 3, and Client Room 4. Staff room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 113.9 degrees F and 114.2 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. The facility has (1) fire extinguisher that was charged and checked on December 11, 2023. The smoke detectors and carbon monoxide were operable. A working telephone (714-519-3082) remains available.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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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 3
FACILITY NUMBER: 306006093
VISIT DATE: 04/26/2024
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LPA conducted five (5) clients and four (4) staff interviews.

Due to time constraint a continuation of this inspection will be conducted at a later date. LPA will conduct record review for staff and resident, and medication review at a later date.

An exit interview was conducted, and a copy of this report was provided to Administrator Claudia Olteanu.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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