<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601387
Report Date: 05/09/2022
Date Signed: 05/09/2022 12:03:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/09/2022 12:03 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:SUNRISE HOME CAREFACILITY NUMBER:
015601387
ADMINISTRATOR:PASCUT, MIHAELAFACILITY TYPE:
740
ADDRESS:7254 ELBA COURTTELEPHONE:
(510) 754-8122
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:6CENSUS: 0DATE:
05/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Mihaela Pascut, LicenseeTIME COMPLETED:
12:13 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/09/2022 at 11:13 am Licensing Program Analyst (LPAs) J. Clancy-Czuleger and K. Nguyen arrived unannounced for a Health and Safety Check. LPAs met with Licensee Mihaela Pascut.

During the visit LPAs observed that there are currently no resident residing at the facility. LPAs checked Carbon Monoxide detector, Smoke Detector, Fire Extinguisher and Emergency Exits.

LPAs reminded the Licensee that the fire extinguishers need to be serviced by the fire marshal or replaced each year.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1