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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 12/20/2022
Date Signed: 12/20/2022 01:46:17 PM


Document Has Been Signed on 12/20/2022 01:46 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
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: 40DATE:
12/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kaye Key, Administrator TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Kaye Key, Administrator, who was finishing listening to a Department Webinar. Currently, there are (40) residents and (8) residents on hospice.

Prior to initiating today's inspection, LPA completed required COVID-19 protocols and was screened per Covid-19 precautionary measures upon entering the facility.and was wearing a surgical mask. LPA confirmed there are currently no active Covid cases at the community. The community completed a second round of testing on 12/16/22. All results were negative except for (3) staff who received an "invalid" response- retesting to be conducted today.

The facility is licensed for (78) bedridden residents and has a hospice waiver for (10) and has been approved for delayed egress and a locked perimeter. LPA and the Administrator toured the interior and exterior of the Assisted Living Unit (ALU) and the Memory Care Unit (MCU) of the facility. Areas toured in each section include a medication room, dining room, activity room, resident room/bathroom, laundry area and common areas. Also toured were the main kitchen, lobby area and salon. LPA observed the facility to be clean, in good repair, odor free and the bathrooms to have paper towels, soap, trash cans. LPA observed a 20-second hand-washing poster above each bathroom and kitchen sink. Fire extinguishers observed throughout and to have last been serviced on 6/22/2022. LPA observed multiple exit doors and the front entrance door to be equipped with an egress door alarm. LPA observed hand sanitizers in the common areas and required postings and multiple Covid posters displayed. There is an enclosed courtyard/patio area in both ALU and MCU, and a small golf putting green on the ALU side. LPA observed the inside temperature to vary from 72-75*F. LPA observed a posted activity schedule in ALU and MCU. LPA observed kitchen to contain 2+/day perishable and 7+day/non-perishable supply of food and the kitchen and ice machine to be clean and sanitary. LPA observed the medications to be locked in the medication room and toxins to be locked in the laundry area. LPA observed sufficient PPE supplies on hand and all staff to be wearing a mask.
cont on 809C..
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 12/20/2022
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809C(1)..LPA and Administrator discussed the vaccination status of residents and staff. The facility conducts monthly fire drills. LPA observed schedule.

All staff are cleared and associated to the facility.

LPA and Administrator completed the Infection Control Domain on the Inspection Tool.

LPA obtained a copy of LIC308 and current liability insurance today. LPA requested an updated copy of LIC500 be sent to CCLD by 12/30/2022.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
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