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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700068
Report Date: 04/19/2024
Date Signed: 04/19/2024 01:41:39 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/19/2024 01:41 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SUNNY SIDE CARE HOMEFACILITY NUMBER:
312700068
ADMINISTRATOR:MICLEA, DAVIDFACILITY TYPE:
740
ADDRESS:4120 SECRET RAVINE WAYTELEPHONE:
(916) 625-9487
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 0DATE:
04/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:David MicleaTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Friday April 19, 2024 to conduct the unannounced annual inspection.

LPA toured the facility with Administrator David. There are currently no residents in care. LPA and David walked the facility together. The facility was well maintained. The pool had a locked fence and was inaccessible.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.


SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
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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