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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403028
Report Date: 07/21/2023
Date Signed: 07/24/2023 11:54:35 AM


Document Has Been Signed on 07/24/2023 11:54 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:SUNRISE AT CANYON CRESTFACILITY NUMBER:
336403028
ADMINISTRATOR:SEGURA, HEATHERFACILITY TYPE:
740
ADDRESS:5265 CHAPALA DRTELEPHONE:
(951) 686-6075
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:88CENSUS: 69DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Heather SeguraTIME COMPLETED:
12:00 PM
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n 7/21/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator Heather Segura who was informed of the purpose of the visit.
LPA toured the facility’s interior and exterior with Administrator Segura. The facility is made up of three (3) cottages, two (2) of which are designated for assisted living and one (1) for memory care. The facility is licensed for 88 non-ambulatory residents of which three (3) may be bedridden. The memory care unit is approved for delayed egress. During the tour, LPA tested the delayed egress and observed it to be operational. Facility has a hospice waiver for 20 residents and Administrator Segura stated the facility currently has 13 residents on hospice. The facility has large dining rooms, kitchen, and other areas throughout the building for residents to sit and relax. The outside area provides shaded seating available for resident use. Indoor and outdoor passageways are free of obstruction. LPA observed fire alarm systems, carbon monoxide detectors and fire extinguishers throughout the cottages. There are no bodies of water on the premises. Food was stored in a safe and healthful manner. Facility met Departmental requirements for 2-day perishables and 7-day non-perishable food items. Resident interviews revealed kitchen staff accommodate residents’ dietary needs. There are several activities and outings available for resident leisure. Medications are secured in medication carts, only accessible to authorized personnel such as wellness nurses and/or MedTechs. Cleaning solutions, knives and sharp instruments are secured and inaccessible to the residents. Fireplaces have appropriate barriers to make them inaccessible for residents.

During this visit, LPA did not observe any deficiencies. A copy of this report was discussed and provided to Administrator Segura.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
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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