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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880793
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:08:50 AM


Document Has Been Signed on 05/12/2023 10:08 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:SUNLIT GARDENS ASSISTED LIVINGFACILITY NUMBER:
361880793
ADMINISTRATOR:STEVENSON, CHERYLFACILITY TYPE:
740
ADDRESS:9428 19TH STREETTELEPHONE:
(909) 481-2600
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:100CENSUS: 95DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Brent Broadhurst, Executive DirectorTIME COMPLETED:
10:00 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunlit Gardens Assisted Living Facility for the purposes of collecting additional information related to a complaint investigation. LPA introduced self and stated purpose of the visit. LPA signed in and met with Executive Director, Brent Broadhurst, who escorted LPA to the resident's room.

No deficiencies observed during the visit, an exit interview was conducted where this report was discussed, reviewed and provided to a Facility Representative.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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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