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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700897
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:32:35 PM

Document Has Been Signed on 10/20/2022 02:32 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:SUNGARDEN VILLA IIFACILITY NUMBER:
342700897
ADMINISTRATOR:ROBINSON, CURTISFACILITY TYPE:
740
ADDRESS:8381 BUNCHBERRY CTTELEPHONE:
(916) 560-3162
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Russelle Robinson, Administrator DesigneeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Jason Geron, caregiver and explained purpose of inspection. LPA met with Administrator Designee, Russelle Robinson, who arrived at 1:00 pm. LPA observed a second caregiver, Ruby Aguilar, also present. LPA observed (1) resident in the common area watching television and (5) residents to be in their rooms at the start of the inspection. Currently, there are (0) residents on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Prior to initiating today's inspection, LPA completed required COVID-19 protocols. LPA was screened per Covid-19 precautionary measures upon entering the facility. and the following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA and toured the Administrator Designee toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with half bath, (2) full bathrooms, kitchen, staff room and locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and medications to be secured nearby. LPA observed the inside temperature to be 78*F. Fire extinguisher was last serviced 6/23/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols. Booster flyers provided. Administrator indicated there will be an on-site flu clinic later this month as a booster clinic was completed recently. LPA observed multiple Covid posters and resources posted throughout as well as other required postings. LPA observed copy of approved Mitigation Plan, Infection control plan and monkey pox plan. LPA observed (1) unlocked gate from the inside back patio and a second locked gate for the gated pool. LPA observed copy of RCFE Administrator certificate # 6056696740-exp 12/9/2022.

LPA obtained an updated copy of LIC500, LIC308 and current liability insurance today.
There are no deficiencies issued during today's inspection.
Exit interview with Administrator. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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