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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801625
Report Date: 02/08/2023
Date Signed: 02/08/2023 03:27:12 PM

Document Has Been Signed on 02/08/2023 03:27 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 MANOR, LLCFACILITY NUMBER:
565801625
ADMINISTRATOR:JULIANA ANOSFACILITY TYPE:
735
ADDRESS:441 WEST CHANNEL ISLAND BLVDTELEPHONE:
(805) 240-7600
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 60CENSUS: 56DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Julie AnosTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required - 1 Year inspection at the facility today. The LPA met with Administrator Julie Anos and explained the reason for the inspection.

Beginning at 10:26 AM, the LPA conducted a physical plant tour of the facility grounds with Administrator Julie Anos to ensure there are no health and safety concerns and facility is in compliance with Title 22 Regulations.

COMMON AREA: The LPA observed the downstairs common TV room area. The smoke alarm was tested and operational. The central entry point for symptom screening for residents, staff and visitors is in this common area. Fire extinguishers observed were fully charged and last serviced 09/27/2022. RESIDENT APARTMENTS: The LPA conducted a tour of a random selection resident apartments on the first and second floor. Each apartment has two bedrooms, a common living area, a bathroom and storage area. Bathrooms in each apartment had a supply of hand soap and paper towels. House keeping cleans the apartments every day except on holidays. In apartment #7, at 10:37 AM, the hot water temperature measured at 78 degrees F after letting the water run in excess of 10 minutes. The LPA also observed bed bug feces in the corner of the ceiling and walls in bedroom A of apartment #7. In apartment # 2, the hot water measured at 133 degree F; apartment #4 137.7 degrees F; apartment #17 122 degrees F; apartment # 11 109 degrees F; and in apartment #9 100.5 degrees F. Smoke alarms and carbon monoxide detectors were tested in each apartment observed during the visit and were operational. In apartment #11 the LPA observed a fly strip in the bathroom with a large amount of small flies stuck to it and more small flies along the ceiling of the bathroom. In bedroom #10 the bathroom sink was plugged.

Report continued on LIC 809-C.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE MANOR, LLC
FACILITY NUMBER: 565801625
VISIT DATE: 02/08/2023
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KITCHEN: At 11:11 AM, the kitchen and dining room were observed. The LPA observed lunch being prepared. The facility had a sufficient supply of perishable and non-perishable foods. MEDICATIONS: Medications were locked and centrally stored in the medication room.

Infection Control: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The facility has a sufficient supply of personal protective equipment. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

During the inspection, the Administrator stated they did have an issue with bed bugs in the past but a pest control services comes monthly to the facility and sprays each apartment. House keeping cleaned most of the bed bug feces off the wall in apartment #7 during the visit but more needs to be cleaned off. The difficulty to regulate the water temperature at the facility through the years was discussed. The facility is currently working with Ventura County to obtain funding for upgrades, including plumbing for the facility.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were provided.


SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/08/2023 03:27 PM - It Cannot Be Edited


Created By: Kasandra Lopez On 02/08/2023 at 11:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE MANOR, LLC
FACILITY NUMBER: 565801625

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2023
Section Cited

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80088(e)(1) Hot water temperature controls shall be maintained to...regulate temperature of hot water ...used by clients to attain a hot water temperature of not less than105 degrees F and not more than 120 degrees F. This requirement is not met as evidenced by:
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Based on observation, the licensee failed to comply with the section cited above as the hot water temperature was below 105 degrees F in two apartments and above 120 degrees F in three apartments which poses an immediate health and safety risk to residents in care.
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Type B
02/13/2023
Section Cited

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80087(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.(1)The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidence by:
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Based on observation, the licensee did not comply with the section cited above as apt 7 had bed bug feces on the walls, apt 10 had a plugged sink, and apt 11 had a large amount of dead and alive small flies which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Desaree Perera
LICENSING EVALUATOR NAME:Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


LIC809 (FAS) - (06/04)
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