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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006093
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:28:58 PM

Document Has Been Signed on 05/01/2024 01:28 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:
05/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Keylan MenesesTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On May 1, 2024, around 11:40am Licensing Program Analysts (LPA) Edward Kim and Jerome Haley arrived to complete the required 1-year annual visit that was started April 26, 2024. LPAs Kim and Haley were greeted and granted entry by Direct Support Professional (DSP) Keylan Meneses. A phone call was placed to Administrator Claudia Olteanu who could not attend with today's visit.

During the visit, LPAs conducted a full audit of all staff files, client files, all client medications, and a review of client P&I funds. The first aid kit was reviewed and contained all the required items.

No deficiencies cited during this visit.

An exit interview was conducted, and a copy of this report was provided to staff.


SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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