306006300-5-13-2024-22-AS-RQUZ-D58VT2-20240513164226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006300
Report Date: 05/13/2024
Date Signed: 05/13/2024 04:43:17 PM

Document Has Been Signed on 05/13/2024 04:43 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SUNRISE OF ORANGE		FACILITY NUMBER:	306006300
ADMINISTRATOR:	BAGHERI, TINA		FACILITY TYPE:	740
ADDRESS:	1301 E LINCOLN AVENUE		TELEPHONE:	(710) 450-4645
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	139	CENSUS: 50	DATE:	05/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Bryan Reamer-Yu, Executive Director		TIME COMPLETED:	04:45 PM

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On today’s date, Licensing Program Analysts (LPA) Rosie Quiroz and Rose Ruppert conducted an unannounced visit for the purpose of conducting an annual required evaluation. LPAs were greeted upon entry to the facility by front desk concierge. LPAs met with Executive DIrector (ED) Bryan Reamer-Yu and Crystal Vital, Resident Care Director (RCD) and explained the purpose of the visit.

Bryan Reamer-Yu has an Administrator certificate with expiration date of August 25, 2024 .

The facility is licensed to provide services to residents age range 60 and over, (139) Non-ambulatory, of which 10 may be bedridden. Approved for delayed egress, and has a hospice waiver for (10) ten residents. There are currently two (2) residents receiving hospice care services.

Between 9:25am-1:00pm, LPAs reviewed ten (10) resident files and ten (10) personnel files.

LPAs along with (ED) Bryan Reamer-Yu and (RCD) Crystal Vital toured the interior and exterior of facility premises including memory care and Assisted Living area. The required two (2) day perishable and seven (7) day non-perishable food supply was observed. Toxic substances were locked and inaccessible to residents. LPAs observed cooking areas to be maintained with cleanliness. LPAs observed facility refrigerator and freezer to be operational and met regulatory requirements. Resident bathrooms were observed to have working sinks, faucets and flushing toilets. LPAs tested hot water temperatures in resident bathrooms which ranged between 118.0 degrees- 118.7 degrees Fahrenheit. Grab bars and non-skid mats were also observed in resident bathrooms. Personal hygiene items for resident use were observed in each bathroom. LPAs observed all resident rooms to have required linens, furnishings, and adequate lighting. All linens and furnishings were clean and in good repair. Smoke alarms and carbon monoxide detectors were last serviced on 4/9/2024. The medications were inaccessible to residents, centrally stored and maintained in compliance. All pathways, doorways, and emergency exits were observed to be free of obstruction. There were no bodies of water observed anywhere on the property. PPE stored in storage room located in the second floor area. CONTINUED ON LIC 809-C PAGE....

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE OF ORANGE	FACILITY NUMBER: 306006300
	VISIT DATE: 05/13/2024

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CONTINUED...While conducting facility inspection and resident interviews, LPAs pulled chord in Resident 7(R7) bedroom area at 2:51pm. At 2:58pm, LPAs inquired about call light response system to R7's bedroom area, ED Reamer-Yu verified no response indicating there was a system in place alerting staff of call light pendants. At 2:58pm, LPAs observed call light for Resident 11 (R11) had been pressed at 2:14pm with no response time. LPAs interviewed R11 who indicated "I pressed the call light 40 minutes ago and no one came by, my wife went to go look for someone but no one came and I wanted to go to bible study." This was verified with ED Reamer-Yu present. (SEE LIC 809-D)
LPAs observed staff answer facility telephone which verified a working telephone was maintained at the facility. Regulatory required postings were observed in multiple places throughout the facility. The Facility was operating within the allowed capacity. Fire extinguishers were charged, mounted throughout the facility and last serviced 7/12/2023. Facility indicated Pest Control services facility monthly, last serviced on 4/10/2024. LPAs verified that fire/disaster drills are conducted monthly and on each shift. Last fire drill was conducted on 4/10/2024. The Emergency exit plans were posted and available for reference throughout the facility. Residents were accorded clean and comfortable accommodations. LPAs observed Laundry area on all floors with funcitonal and operational washers and dryers.

Based on the observations made during today’s visit, the facility is being cited per Title 22, Division 6, of California Code or Regulations. An exit interview was conducted with ED Bryan Reamer-Yu. A copy of today's report, LIC 809-D, Appeal rights and LIC 858 and LIC 859 pages were provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/13/2024 04:43 PM - It Cannot Be Edited

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: SUNRISE OF ORANGE	FACILITY NUMBER: 306006300
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87411(a)

Personnel Requirements-General 87411(a): Facility personnel shall at all times be sufficient in numbers, and competent to provide their services necessary to meet resident needs. In facilities licensed for 16 or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required... This requirement is not met as evidenced by: At 2:58pm, during facility inspection and interviews with residents, LPAs observed call light for resident 11 had not been responded to. R11 indicated "I pressed the call light 40 minutes and no one came by, my wife went to go look for someone but no one came." This was verified with ED Reamer-Yu present.
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to residents in care.
	POC Due Date: 05/20/2024
	Plan of Correction
1 2 3 4	ED Reamer-Yu agreed to provide inservice to staff on call light pendant system and develop a plan to monitor call light system response time by POC due date of 5/20/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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