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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425525
Report Date: 04/23/2024
Date Signed: 04/23/2024 11:20:01 AM


Document Has Been Signed on 04/23/2024 11:20 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:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SALAS, DIANAFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 79DATE:
04/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Karen Roper - Executive DirectorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Crystal Colvin conducted an unannounced case management visit in order to increase the capacity per licensee request. LPA Colvin met with Executive Director Karen Roper and explained the purpose of the visit.

Licensee requested for a capacity increase from 81 residents to 116 residents, which includes 5 bedridden residents, and all residents able to be non-ambulatory. A Fire Clearance was approved on 2/13/24 for 111 non-ambulatory residents and 5 bedridden residents, for a total of 116 residents. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Colvin discussed the facility sketch with Executive Director Karen Roper. There were no changes to the facility's physical plant, but private bedrooms are being changed to shared bedrooms. Resident bedrooms #54, #39, & #38 (all in Memory Care) have been approved for bedridden residents. LPA Colvin and toured the interior/exterior of the building and visually inspected all bedridden resident bedrooms, as well as a sample of non-ambulatory resident bedrooms. LPA Colvin confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. LPA Colvin additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms (all bedrooms have private bathrooms with showers).

The physical plant is ready for increase in capacity. LPA Colvin has notified Executive Director Karen Roper of final capacity increase approval. LPA Colvin further advised Executive Director Karen Roper that the new license will follow in the mail after capacity increase visit.

An exit interview was conducted where this report was discussed and a copy was provided to Executive Director Karen Roper.
***LPA Colvin was not in the facility from 10:45am - 11:15am****
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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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