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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802272
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:01:37 PM


Document Has Been Signed on 06/06/2024 01:01 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SUNRISE TERRACE RCFE IIFACILITY NUMBER:
405802272
ADMINISTRATOR:SADORRA, HECTORFACILITY TYPE:
740
ADDRESS:1338 ROYAL WAYTELEPHONE:
(805) 541-1843
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:6CENSUS: 0DATE:
06/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Edwin Ingan - LicenseeTIME COMPLETED:
02:00 PM
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 On 06/06/2024 at 12:00PM LPA Jeffries conducted a case management visit to the facility to observed results from new construction due to facility flooding in February of 2024. LPA received a copy of STD850 (Fire Clearance) from San Luis Obispo Fire Department showing facility is cleared for 6 residents, 6 can be non ambulatory and 1 can be bedridden. LPA observed new flooring throughout the facility, new HVAC system and new and painted dry wall. LPA observed for any reminisce of construction that could pose a hazard to residents in care and found the facility to be clean and in good repair. LPA noted that Licensee express that they were going to move first resident back into the facility on 06/15/2024. LPA had no objections.

Exit interview, report read, and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024
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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