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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 04/08/2024
Date Signed: 04/08/2024 05:12:30 PM


Document Has Been Signed on 04/08/2024 05:12 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:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:SUMMERHAYS, CALEBFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 49DATE:
04/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Danny Torgersen, Asst. AdministratorTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to an incident report recently submitted to the Department. LPA met with Daniel Torgersen
Assistant Administrator, and explained purpose of inspection.

During today's inspection, LPA and Administrator discussed how on the afternoon of 3/29/24, resident (R1) had a change in behavior towards staff and other residents and began screaming. Staff notified the Lead Med-Tech staff who was not able to calm resident down, so he was sent to the Emergency Room for further evaluation. Resident returned the same day but then was sent out a second time on 3/31/24, returning on 4/2/24. When he returned on 4/2/24, he had (2) new medications. Resident seems to be adjusting to the new medications as the behaviors have decreased.

LPA and Administrator discussed both incidents.

There are no deficiencies cited in this report.

Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024
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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