Community Care Licensing

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At 10:00am on 09/14/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee Edwin Ingan, and Administrator Hector Sadorra, announced who he was and the reason for the visit. This facility is a 5* bedroom, 3 bathroom, living room, small dinette/pantry table room, kitchen, dining room, backyard and front yard. Bedroom Number 5 is a dual resident occupancy and the other 4 bedrooms are single resident occupancy. Bedroom one has an on suite bathroom for residents use and the other two bathrooms are available for use for all facility residents. Both backyard and front yard have tables and umbrellas that provided shade in the outside areas of the facility. All bedrooms meet regulations requirements with lighting, linin and storage. There is liquid soap and paper towels in all bathrooms, and water temperature was tested with in regulation range of 105*-120* (f). The facility has working smoke detectors throughout the facility and a working carbon monoxide detector. There is a fire extinguisher located in the green in the kitchen. All exits were observed by LPA to be free and clear of obstructions. All required postings are located in the entry way and in the small dinette area of the facility. LPA observed at least 2 days of perishable and at least 7 days on non-perishable foods. Medications are secured and stored in the entrance hallway closet. LPA observed the facility to be clean and in good repair. LPA observed bedroom 5 to be a new additional room that was prior identified on facility sketch as living room 2. LPA cited Licensee for 87202(a) fire clearance violation. Licensee will provide a new facility sketch and request for new fire clearance inspection to LPA within 24 hours of this report. LPA and Licensee did a complete review of the inspection care tools, LPA noted that there was one violation as noted above. There were no other violations noted during the complete review of the annual care tools review. Citation issued, report read, report singed, report and appeal rights provided.

SUPERVISOR'S NAME: Kelly Burley TELEPHONE: (805) 562-0413 LICENSING EVALUATOR NAME: Mark Jeffries TELEPHONE: (805)562-0400 LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023

Document Has Been Signed on 09/14/2023 01:49 PM - It Cannot Be Edited

FACILITY NAME: SUNRISE TERRACE RCFE II	FACILITY NUMBER: 405802272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

Type B

Section Cited

CCR

87202(a)

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Kelly Burley TELEPHONE: (805) 562-0413 LICENSING EVALUATOR NAME: Mark Jeffries TELEPHONE: (805)562-0400 LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023