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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002828
Report Date: 10/07/2022
Date Signed: 10/07/2022 01:17:03 PM


Document Has Been Signed on 10/07/2022 01:17 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:SUNRISE SENIOR CAREFACILITY NUMBER:
345002828
ADMINISTRATOR:HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:6729 SUGAR MAPLE WAYTELEPHONE:
(916) 200-8447
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:5CENSUS: 4DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anita Heydon, Administrator TIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Danielle Fabyunkey Lawrence, caregiver and explained purpose of inspection. LPA met with Anita Heydon, Administrator who arrived at 11:15 am and spoke to Licensee by phone regarding newly converted resident room. Also, House Manager, Ram Pratap, arrived also at 11:15 am from grocery shopping. LPA observed (2) residents in the common area and (2) residents to be in their rooms at the start of the inspection. The facility is currently licensed for (5) non-ambulatory residents; however, was approved on 9/23/2022 by the fire department for (6) residents- (2) ambulatory (rm #1- newly converted room, currently vacant) and (4) non-ambulatory residents. Currently there are (0) residents receiving hospice services. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and was screened per Covid-19 precautionary measures upon entering the facility. and was wearing a surgical mask.

LPA and Administrator toured the interior/exterior of the facility including common areas, resident bedrooms (5), resident bathrooms (2), kitchen, and laundry area/garage. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have grab bars, non-skid flooring, paper towels and 20-second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food. LPA observed multiple toxins to be unlocked below the kitchen sink and the drawer containing sharps to be currently unlocked. LPA observed medications, including those needing refrigeration, to be secured nearby. LPA observed the inside temperature to be 76*F. Fire extinguisher last serviced 6/6/2022. Discussed vaccination status of residents/staff, boosters and visitation protocols- booster flyer provided. LPA observed multiple Covid posters throughout and other required postings. LPA observed (1) unlocked gate from the inside back patio.LPA observed sufficient incontinent products and PPE. LPA requested an updated copy of LIC500, LIC308, LIC200 and current liability insurance be provided to the Depart by 10/14/22.

Per California Code of Regulations, Title 22, Division 6, Chapter, 8, the following (1) deficiency is cited on the 809D page. Exit interview. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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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Document Has Been Signed on 10/07/2022 01:17 PM - It Cannot Be Edited

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: SUNRISE SENIOR CARE
FACILITY NUMBER: 345002828

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87705(f)(2)

87705 Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia:

(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as multiple cleaning products were left unlocked, under the sink, which posed a potential health, safety or personal rights risk to persons in care. Additionally, the drawer containing sharps was not locked at the time of inspection.
POC Due Date: 10/21/2022
Plan of Correction
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Administrator immediately removed the cleaning products and placed them in a secured area. Administrator to install a lock on the cabinet under the kitchen sink if wishing to place toxins there. Administrator immediately locked the drawer when discovered unlocked. Administrator agrees to read Regulation 87705 with staff and submit a signed statement that the regulation is understood. Submit by 10/21/22 by fax or email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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