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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920097
Report Date: 05/17/2024
Date Signed: 05/17/2024 03:12:16 PM


Document Has Been Signed on 05/17/2024 03:12 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:SUNRISE RANCH CARE HOMEFACILITY NUMBER:
345920097
ADMINISTRATOR:UGBO, BLESSINGFACILITY TYPE:
740
ADDRESS:8225 EVA RETTA CTTELEPHONE:
(916) 598-8989
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
05/17/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Blessing Ugbo, Administrator TIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a scheduled pre-licensing inspection. LPA met with Blessing Ugbo, Administrator, and Fubara Jack and Esosa Ogunbor, members.
There is a pending license for (6) residents, all of whom may be non-ambulatory. There are currently no residents present as this location is not currently licensed.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, laundry and garage.
LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout.
The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels. Administrator to post a 20-second hand-washing poster at each sink. LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. The freezer/refrigerator temperatures are within regulation. Sharps and toxins are locked in the kitchen and there are additional locked toxins in the garage. Medications will be locked in a medication cart. Hot water measured 110*F in the kitchen and the inside temperature measured 74*F. Fire extinguishers were last serviced on 11/6/23, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit, PPE/paper supplies, and sufficient linens/towels/blankets.
There are flashlights and night lights on hand. Resident rooms are completely furnished. There are various required postings posted, including the Emergency Disaster Plan and resident Personal Rights. There are games/activities and an operating land line. All exit doors have alarms. There is a patio table and chairs-the canopy cover is on order and will arrive by next week. There are (2) exit gates in the backyard. LPA observed folders to be set-up for staff and resident files. Discussed staff training program- approved on-line vendor.
RCFE Administrator #6066389740 (exp 5/15/25) posted.

Component III was reviewed during today’s inspection.
Pre-Licensing is complete and this facility has no deficiencies.

Exit interview. Copy of report left at facility. LPA to notify to the Centralized Applications Bureau.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024
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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