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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700897
Report Date: 10/03/2023
Date Signed: 10/03/2023 04:42:57 PM

Document Has Been Signed on 10/03/2023 04:42 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: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:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Russell Robinson, Administrator TIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection LPA met with Jason Geron, caregiver and with Administrator Designee, Russelle Robinson, and explained purpose of inspection. Also present was caregiver, Bernard Castro. There are currently (6) residents and (2) residents under hospice care.
The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3).

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 76*F. Fire extinguisher was last serviced 6/5/23 and facility conducts quarterly fire drills- last drill conducted 8/7/23. LPA reviewed the Infection control plan (completed Aug 2022). LPA observed (2) unlocked gate from the inside back patio and a third locked gate for the gated pool. LPA observed copy of RCFE Co-Administrator certificate # 6056696740-exp 12/10/2024 and Administrator certificate #605337740- exp 6/14/24. LPA reviewed (3) resident files and found them to be organized and contain current paperwork. LPA and Co-Administrator reviewed ordered medications for (2) residents to those being administered and found no discrepancies. LPA reviewed (3) staff files- all staff is fingerprint cleared, associated and has current First Aid/CPR. In addition, all staff have completed the required training (topics/hours) in 2023 through an approved on-line provider. LPA observed (2) signatures for destroyed medications on LIC622.
LPA obtained an updated copy of current liability insurance today and staff roster information.
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: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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