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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006219
Report Date: 02/16/2023
Date Signed: 02/17/2023 08:17:11 AM


Document Has Been Signed on 02/17/2023 08:17 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:STERLING SENIOR COMMUNITY 7FACILITY NUMBER:
306006219
ADMINISTRATOR:LALAP, DONNAVEE C.FACILITY TYPE:
740
ADDRESS:9231 EL CORTEZ AVETELEPHONE:
(714) 847-1364
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
02/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Albert PimentelTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Lydia Martinez conducted an announced visit at this facility for the purpose of completing a Pre-Licensing evaluation. Facility is an existing facility and undergoing a Change of Ownership. There are 6 residents in care under current license. An application to operate a Residential Care For the Elderly (RCFE) was submitted to the Central Applications Unit (CAU) on 07/28/2022 for a capacity of 6 residents. A Fire Clearance was granted for 6 non-ambulatory of which 1 can be bed ridden (bedroom 5) on 01/23/2023. LPA met with Applicant Albert Pimentel and Administrator Donnavee C. Lalap.

Facility is a 6 bedroom downstairs, 2 staff bedrooms upstairs, 4 bathroom, two story house. LPA toured the entire premises. Fire extinguishers were mounted and charged. Smoke detectors have been tested. There was a locked area for medications. Sharps were stored in a locked kitchen drawer and toxins and cleaning supplies were locked under kitchen sink and also stored in the garage. Beds are made with appropriate linens. Furniture appeared safe and adequate. Hot water in bathrooms is tested and is within regulatory requirements.

This applicant has also submitted a request for a Hospice Waiver and a plan to care for residents with Dementia.

Component III was waived during the visit due to applicant is a current licensee for 7 RCFE's and they are in substantial compliance.

The Pre-Licensing is complete and this facility has no deficiencies. All elements verified by LPA appear to be in compliance and the facility is ready to be licensed. The license will be granted upon completion of a final review and approval from the Application Specialist.

An exit interview was conducted and a copy of this report will be emailed to email on file.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
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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