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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001968
Report Date: 03/20/2023
Date Signed: 03/20/2023 02:51:47 PM


Document Has Been Signed on 03/20/2023 02:51 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:SUNRISE OF ROCKLINFACILITY NUMBER:
315001968
ADMINISTRATOR:MARIANNE RICHARDSONFACILITY TYPE:
740
ADDRESS:6100 SIERRA COLLEGE BLVDTELEPHONE:
(916) 632-3003
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:82CENSUS: 48DATE:
03/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Marianne RichardsonTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Monday March 20, 2023 to conduct the annual inspection. LPA wore a surgical mask during todays visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (5) and staff (8) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA Parks and Administrator Marianne toured the facility together to ensure the health and safety of residents in care. The areas toured included resident apartments, kitchen, hallways, memory care apartments, memory care dining room/kitchen, and memory care common areas. Water temperatures in the apartments toured were within the required range of temperature. LPA observed the facility's emergency food and water storage and PPE storage. In the areas toured, there were no health or safety violations observed.

LPA Parks reviewed fire drills from December 2022 - March 2023. All required postings were observed in the lobby area.

LPA requested the facility to update their LIC500 and email to LPA by April 15, 2023.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
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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