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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920051
Report Date: 11/17/2023
Date Signed: 11/17/2023 12:25:50 PM

Document Has Been Signed on 11/17/2023 12:25 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:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR:GALVEZ, JESSICAFACILITY TYPE:
740
ADDRESS:1041 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 199CENSUS: 25DATE:
11/17/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica GalvezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 11/17/23 to conduct a Post Licensing Inspection utilizing the CARE inspection tool. LPA met with the Executive Director (ED)/ Administrator and explained the purpose of the visit. .

LPA and ED toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, 1 resident bedroom, med rooms, kitchen and dining, and The Gardens (Memory Care section). In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed resident files. Files were complete. LPA and ED discussed ensuring physician reports in a non-standard LIC 602 format be double checked for completeness of required information.

Staff files were reviewed. Files are complete. LPA and ED discussed consolidating/ organizing files to have required forms and training in one place to help the review be more efficient.

LPA requested resident roster and LIC 500 be submitted.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted. Report provided copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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