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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700765
Report Date: 08/30/2021
Date Signed: 08/30/2021 01:16:18 PM

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:SUNRISE SENIOR CAREFACILITY NUMBER:
342700765
ADMINISTRATOR:HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:6729 SUGAR MAPLE WAYTELEPHONE:
(916) 560-8903
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 3DATE:
08/30/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Steve Heydon, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete a plan of correction visit . LPA met with Administrator Steve Heydon during today's inspection. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. Additionally, LPA was screened by staff upon entering the facility.
LPA observed facility has corrected the following:
  • Administrator sent resident incident report into CCL.
  • R1's needs and service plan was completed.

Administrator stated once TB test is received, facility will send health screening and TB test into CCL.

No deficiencies cited during today's visit. Letter of correction printed for licensee.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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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