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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800436
Report Date: 03/12/2025
Date Signed: 03/12/2025 10:14:48 AM

Document Has Been Signed on 03/12/2025 10:14 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:JOHN RUSSELL SUNRISEFACILITY NUMBER:
331800436
ADMINISTRATOR/
DIRECTOR:		RUSSELL, JOHNFACILITY TYPE:
740
ADDRESS:79150 BUFF BAY COURTTELEPHONE:
(909) 496-4636
CITY:BERMUDAS DUNESSTATE: CAZIP CODE:
92203
CAPACITY: 3TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
03/12/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:John RussellTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On 03-12-2025, Licensing Program Analyst (LPA), Abdoulaye Zerbo made an announced visit for the purpose of conducting the final facility closure visit. LPA was greeted and granted entry by the Licensee, John Russell.

The department learned of the closure on 12/30/2024. Licensee notified the department to advise of their intentions on voluntarily closing the facility. During today's visit, LPA toured the interior and exterior of facility with licensee John Russell, and observed three(3) of four (4) bedrooms to be vacant, and one(1) bedroom with one(1) resident. According to licensee, the resident is relocating on 03-12-25. LPA Zerbo confirmed the relocation of the resident by calling the facility.

The Licensee surrendered their original License on 03/12/25 (Effective Date: 03/18/2025). The LPA explained to licensee that the license will no longer be valid, and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.

An exit interview was conducted, and a copy of this report was provided to the licensee John Russell.

Rikesha StampsTELEPHONE: (951) 212-0616
Abdoulaye ZerboTELEPHONE: (951) 248-2222
DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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