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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425525
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:49:02 PM


Document Has Been Signed on 06/23/2022 04:49 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:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SHANNON JOHNSONFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 53DATE:
06/23/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Office Manager- Leticia MartinezTIME COMPLETED:
04:50 PM
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On 6/23/22 Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA Arreola met with office manager, Leticia Martinez, and explained the purpose of the visit.

At the time of the visit there was (16) staff and (53) clients present. LPA conducted a tour of the facility assisted living and memory care unit. LPA observed residents in their rooms and common areas in the assisted living area of the facility.

LPA was informed by office manager that the memory care unit had residents with a skin rash similar to scabies, but not confirmed. LPA was able to walk around the memory care unit and look inside resident rooms.

No deficiencies were noted at the time of the visit. No health and safety concerns were observed during the visit.

An exit interview was conducted, and a copy of this report was provided to office manager, Leticia Martinez.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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