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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602274
Report Date: 04/23/2021
Date Signed: 04/23/2021 05:31:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SUNRISE WAY RESIDENCE IIFACILITY NUMBER:
374602274
ADMINISTRATOR:NICOLE J. GUIBERTFACILITY TYPE:
735
ADDRESS:161 MARSDEN CTTELEPHONE:
(619) 441-5982
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 5DATE:
04/23/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Nicole Guibert, LicenseeTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA), Carmen Lopez, conducted an announced virtual visit via FaceTime video-call to initiate a facility evaluation prior to client's return. Virtual visits are conducted due to COVID-19 restrictions. LPA Lopez identified herself, stated the purpose of the video-call, and reviewed the basic elements of the visit with Licensee, Nicole Guibert. Administrator, Beatrice Dobbin, and House Manager, Valasi Niupulusu, were on-site during the tour.

The LPA and facility representatives toured the physical plant and LPA observed the following: resident accommodations, including furnishings, linens, and personal hygiene items; medications are stored in a locked cabinet; food service, including dishes and food storage were observed; toxic substances are stored in a locked cabinet; a first aid kit is currently stored at the hotel and will be stored in the facility upon move in; smoke and carbon monoxide detectors are present and operable; required facility postings are present and visible in a common area of the facility. According to the Licensee, there are no guns, weapons, or ammunition stored on the facility property. No swimming pool nor bodies of water were observed on the facility property. The fireplace is gated, not operable, and is only used decoratively. The facility is clean, safe, sanitary, and in good repair. There were no obstructions observed indoors or outdoors of the facility.

Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. A copy of this report and Applicant Rights (LIC 9058) were provided to the Licensee via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021
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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