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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006200
Report Date: 12/27/2023
Date Signed: 12/27/2023 02:33:11 PM

Document Has Been Signed on 12/27/2023 02:33 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 ASC, 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: 4DATE:
12/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Andrew Crawford - Program DirectorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Mental Health Technician (MHT) Sam Gomez. Case Manager (CM) Sole Contreras and Program Director (PD) Andrew Crawford joined the inspection upon LPA's arrival.

The facility is a one-story home with four client bedrooms, two client bathrooms, kitchen, dining room, living room, therapy room, staff office, staff bathroom, backyard and attached 2-car garage. LPA observed residents to be laying down in their rooms, in the living room or in the backyard. Facility appears clean and sanitary. All client rooms had required elements, including bed, chair, closet space and ample lighting. Facility had extra linens for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured 117.6 degrees Fahrenheit in the common bathroom and 116.6 degrees Fahrenheit in the bathroom in one of the shared rooms. LPA observed facility has emergency food and water supply. LPA observed knives to be locked up in a cabinet in the staff office. LPA observed other hazardous materials like chemicals and cleaners to be locked in a closet in the entryway. Facility has board games, ample activity space and electronics for client enjoyment. Medication for each resident is kept locked in a cabinet in the staff office. The backyard has one large seating area. Exit gates are unlocked and self latching. LPA observed exit gates to be unobstructed. LPA reviewed four of the four client files and verified the accuracy of the stored valuables each client turned into the facility staff upon admission. LPA also reviewed three personnel files. LPA interviewed two staff and two clients.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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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