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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603437
Report Date: 02/21/2023
Date Signed: 02/21/2023 10:41:57 AM


Document Has Been Signed on 02/21/2023 10:41 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:SUNGARDEN TERRACEFACILITY NUMBER:
374603437
ADMINISTRATOR:SUSAN O'SHAUGHNESSYFACILITY TYPE:
740
ADDRESS:2045 SKYLINE DRIVETELEPHONE:
(619) 462-5831
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:110CENSUS: 52DATE:
02/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Susan O'Shaughnessy, AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check for residents in care. LPA identified herself and was granted entry by Pam Sanderson, Receptionist. LPA met with Susan O'Shaughnessy, Administrator and disclosed the purpose of the visit.

During today’s visit, LPA briefly spoke with staff, and requested and obtained resident records. This case management may require further follow-up. No deficiencies were cited during today’s visit.

An exit interview was conducted with Administrator O'Shaughnessy and a copy of this report and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Administrator at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023
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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