336403028-7-10-2024-18-AS-VMIN-D72S2W-20240710133012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336403028
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:30:19 PM

Document Has Been Signed on 07/10/2024 01:30 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SUNRISE AT CANYON CREST		FACILITY NUMBER:	336403028
ADMINISTRATOR:	SEGURA, HEATHER		FACILITY TYPE:	740
ADDRESS:	5265 CHAPALA DR		TELEPHONE:	(951) 686-6075
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92507
CAPACITY:	88	CENSUS: 69	DATE:	07/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:33 AM
MET WITH:	ADMINISTRATOR, HEATHER SEGURA		TIME COMPLETED:	01:38 PM

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On July 10, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced visit to the facility for the Required One Year Annual inspection, and met with Administrator Heather Segura who was informed of the purpose of the visit. The facility file review was conducted at the Regional Office and additional forms were requested and reviewed on site.

LPA Mixson toured the facility, along with Administrator Segura and made observations following is a summary of what was observed. LPA Mixson toured the facility and inspected the inside and outside of the facility. The facility is located at 5265 Chapala Dr. Riverside, CA. 92507.

Physical Plant: The physical plant is clean, neat, and orderly. Outdoor and indoor passageways are free of obstruction currently and well shaded for visits.

The facility is made up of three cottages, two of which are designated for assisted living and one for memory care. The facility is licensed for 88 non-ambulatory residents and is currently providing serve to 69 Elderly Adults.

The memory care unit is approved for delayed egress. During the tour, LPA Mixson sampled several of the delayed egress doors and observed those sampled to be operational. The facility has a Hospice waiver for 20 residents and Administrator Segura informed LPA that there are currently 19 residents who reside on hospice.

Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. There was a Wellness center and/or nurses station and it was clean and locked. There are about ten to 15 Med-techs and Nurses on staff for medication management and to assist residents with medications.

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SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUNRISE AT CANYON CREST	FACILITY NUMBER: 336403028
	VISIT DATE: 07/10/2024

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Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. LPA observed a menu.

Care & Supervision: Facility has sufficient staff, at the time of this visit. Staff were observed engaging the residents in activities, and the noon day meal.

Records Review: LPA Mixson reviewed six resident and six staff files, conducted staff interviews and resident interviews. Previous Community Care Licensing forms were reviewed. Based on LPA's observations there were no Title 22, Division 6 Regulation violations observed or cited during today’s visit.

An exit interview: was conducted and a copy of this report was explained and proved to Administrator, Heather Segura.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC809 (FAS) - (06/04)

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