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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006200
Report Date: 11/09/2022
Date Signed: 11/09/2022 10:09:13 AM

Document Has Been Signed on 11/09/2022 10:09 AM - 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:SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER LLCFACILITY NUMBER:
306006200
ADMINISTRATOR:VILLARREAL, MICHAELFACILITY TYPE:
772
ADDRESS:25681 SABINA AVETELEPHONE:
(949) 533-4025
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Michael VillarrealTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Jessica Cho made an announced visit for a pre-licensing evaluation. LPA met with Co-Applicant/Administrator Michael Villarreal. The facility has four bedrooms and three full bathrooms. There is a Therapy Office and Staff Office. This is a single story facility with a two car garage. The inspection is as follows:

A fire clearance was granted on July 7, 2022 for 6 ambulatory clients.

LPA toured the interior and exterior of the facility including all client bedrooms and bathrooms. The bedrooms had the required furnishings. The hot water temperature was tested in the client bathrooms and observed to be at 112.4 degrees Fahrenheit in Bathroom #1 and 112.6 degrees Fahrenheit in Bathroom #2. There is sufficient supply of linens and towels. One fire extinguisher was mounted, charged, and serviced on 06/24/2022. Dual functioning carbon monoxide/smoke detectors were centrally wired and are operational.

There is one locked closet for medications in the staff office which included first aid kits. All cleaning solutions were stored in the locked garage. There were several locked closets for storage of toxins and cleaning equipments. The exit gates were self-closing and self-latching. The kitchen was inspected. LPA did not observe 2 day perishable and 7 day non-perishable foods. All CCL signs were posted except the updated Emergency and Disaster Plan for Social Rehabilitation Facilities (LIC610D) and Coronavirus 2019 (COVID-19) precautionary signs on the front door. LPA inspected the outdoor area and there were outdoor furniture under a patio lattice.


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SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER LLC
FACILITY NUMBER: 306006200
VISIT DATE: 11/09/2022
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The following items need to be corrected prior to licensure:

1.) To post COVID-19 signs on the front door and the updated LIC610D
2.) To have sufficient 30-day PPE supplies, emergency food, 2 day perishables and 7 day non-perishables
3.) To obtain the current edition of the first aid manual
4.) To create a sign in sheet to document daily temperatures of visitors
5.) To repair the hole in the garage wall and one right knob on the sink cabinet

Component III was waived because Co-Applicant/Administrator has other licensed facilities and has already completed Component III.

Facility does not appear ready for licensure. Any items noted during today’s visit are to be corrected by Friday, November 18, 2022. Co-Applicant/Administrator will submit the corrections via email to LPA Cho to review the items listed above. An exit interview was conducted with Co-Applicant/Administrator Michael Villarreal, and a copy of this report was provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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