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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 12/23/2021
Date Signed: 12/24/2021 11:14:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 48DATE:
12/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kaye KeyTIME COMPLETED:
01:00 PM
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On 12/23/2021 LPA Tryon arrived at the facility to perform an annual visit using the Infection Control Domain of the annual inspection tool. Prior to the visit, LPA had checked with the facility to ensure they do not have any COVID Positive Residents or staff. The facility has had recent COVID cases and is doing the second round of testing tomorrow, 12/24/21. LPA did a self-screening by taking temperature and reviewing symptoms. LPA wore an N-95 mask and used hand sanitizer. LPA met with Administrator Kaye Key..

LPA toured the facility including common areas, dining room, kitchen, resident apartments, bathrooms, hallway Memory Care Unit, storage, medication rooms.

LPA reviewed the infection control domain with the Administrator. LPA requested a copy of most recent Administrator Certificate, copy of liability insurance, and current staff schedule.

The facility appears to be in substantial compliance at this time.

Exit interview conducted
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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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