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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002980
Report Date: 11/06/2023
Date Signed: 11/06/2023 02:07:04 PM


Document Has Been Signed on 11/06/2023 02:07 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:SUMMER SUNSHINE LLCFACILITY NUMBER:
315002980
ADMINISTRATOR:NICULAI, LEONTINFACILITY TYPE:
740
ADDRESS:859 SHETLAND COURTTELEPHONE:
(916) 755-9463
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 6DATE:
11/06/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Nadia NiculaiTIME COMPLETED:
03:00 PM
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On Monday November 6, 2023, Licensing Program Analyst Melissa Parks arrived to conduct an unannounced postlicensing inspection..

LPA reviewed 4 resident and 2 staff files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. Facility is current on fire drills.

LPA toured the facility with Nadia. The following areas were inspected: backyard, resident rooms, resident bathrooms, kitchen, garage, and common area.

No deficiencies cited. An exit interview conducted. A copy of this report was emailed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
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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