Pacific Sunrise Home I

Type of visit: Required - 1 Year

On 10/31/25, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual inspection. LPA was met by staff one, Jerald Padunan - Assistant Administrator Designee (S1), and later by staff two, Rachel Tuazon - Administrator Designee (S2) and the purpose of the visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver approved for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (5) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and attached garage. Protective devices are in place, including non-slip mats and grab bars in all showers and the average water temperature is 113.6°F (degrees Fahrenheit) and all water sources provide water within title 22 regulations. S1 accompanied LPA's tour of the inside and outside the facility during today's inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Doorways were free of obstructions. During LPA's tour, LPA observed the windows and screens to be in minor disrepair. Please see LIC809-D. Report continues, please see 809-C. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxic cleaning agents were kept in locked storage cabinet. LPA observed the stove in disrepair, please see LIC809-D. First Aid kit was available, along with first aid manual. One fire extinguisher, last serviced September 25, 2025 was observed in the kitchen area. All drills have been conducted, last conducted on 10/02/25. S1 tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional and operated within title 22 regulation. . There have been two deficiencies cited during today's visit, please see 809-D. An exit interview was held with staff two, Rachel Tuazon (S2) and a copy of this report, deficiencies cited and appeal rights were provided to S2.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Other

On 08/21/2025, around 11:00 AM Licensing Program Analyst (LPA) Jose Anguiano conducted a Case Management visit at the facility. LPA met with Assistant Administrator Rachel Tuazon and was granted entry. LPA explained that the purpose of the visit was to conduct a health and safety check for a resident. LPA toured the facility and conducted interviews with one resident and one staff member. Specifically, LPA interviewed Resident (R1) and Staff (S2). No deficiencies were observed during today’s visit. An exit interview was conducted with Rachel Tuazon, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

On 10/12/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator Designee Rachel Tuazon. The facility is licensed to serve six (6) non-ambulatory residents, all of which one (1) may be bedridden. The facility has a hospice waiver approved for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (5) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and attached garage. The facility is clean, sanitary, and in good repair. Protective devices are in place, including non-slip mats and grab bars in all showers. The Assistant Administrator Designee accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Doorways were free of obstructions. Continue to LIC809-C. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced September 20, 2024 was observed in the kitchen area. Assistant Administrator Designee tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. Five staff records were reviewed, five out of five staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. Five resident records were reviewed and, five out of five resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed. No deficiencies are being cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with Administrator Designee Rachel Tuazon.the state’s words, verbatim · CDSS document, Oct 12, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by Raquel Tuazon, Administrator the purpose of today’s visit was explained. There are currently (4) residents in the facility, (3) are non-ambulatory (1) bed bound. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (5) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and attached garage. LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. INFECTIOUS CONTROL PRACTICES - LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked sanitizer/soap and paper towels in all the bathrooms and additional sanitation supplies are stored in hall closet and garage. LPA observed staff wearing masks, Residents private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, infectious Control Plan posted and/or in folder, Emergency infectious Plan posted, required postings throughout the facility. Visitor designated area, resident temperatures are checked and logged (as needed). Emergency contacts updated and posted; PPEs are enough for 30 days. All resident's and staff are vaccinated and boosted. OPERATIONAL REQUIREMENT - Fire clearances are incompliance. PHYSICAL PLANT ENVIRONMENTAL SAFETY - Bedrooms are occupied by residents and contain the mandated furniture. One staff bedroom. Bathrooms have nonskid mats, bars, and are clean and operational. (1) fire extinguisher is fully charged. First Aid kit complete with manual. The water temperature is at 117 degrees Fahrenheit. Linens and personal hygiene supplies are adequate. A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide detectors are complying and operational. hazardous toxins and/or items are inaccessible to residents. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Exit, walkways and/or passageways, front yard and back yard are free of debris and/or hazards. The facility is in good repair. STAFFING AND PERSONNEL RECORD TRAINING - 3 staff files are current with valid CPR cards, egress system operational, no volunteers at the facility. RESIDENTS REC - INCIDENT REPORT- 4 Resident files are current along with medications. RESIDENT'S RIGHTS - Internet access along with computer, visitor policy posted, PUB 475 posted. PLANNED ACTIVITIES - shaded area, indoor and outdoor activity area. FOOD SERVICE - Ample supply of perishable and nonperishable food and menu posted. INCIDENTAL M&D – The MARS is updated and complete. Resident’s medications are being given as prescribed by their physician. DISASTER PREPAREDNESS – The facility has an emergency and disaster plan, staff knows were shut off valves are located, flashlights available along with batteries, cell phones, additional emergency provisions, and conducted fire drill in April 2023. RESIDENT'S W/SHN - Some residents within facility require postural support, residents using oxygen have signs posted on doors. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time An exit interview was conducted with Raquel Tuazon Administrator, a hard copy of report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2023