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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001314
Report Date: 04/03/2023
Date Signed: 04/03/2023 04:32:39 PM

Document Has Been Signed on 04/03/2023 04:32 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:SUNRISE RESIDENTIAL CARE SERVICES, INC. (#2)FACILITY NUMBER:
347001314
ADMINISTRATOR:DICKEY, MAYEFACILITY TYPE:
735
ADDRESS:8139 WACHTEL WAYTELEPHONE:
(916) 725-6647
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 3DATE:
04/03/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Maye Dickey, Administrator TIME COMPLETED:
04:35 PM
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Licensing Program Analysts (LPA) Sabrina Calzada and Ivan Avila arrived unannounced to conduct a health and safety check.. LPA's met with Maye Dickey, Administrator, and explained purpose of inspection. Also present was Jolana Araujo, Alta California Regional Center Service Coordinator and Facility Liaison. LPA's observed additional facility staff present:: LuzviMinda "Mindy" Cailing, Encarnacion Carmen and Erlinda Cailing. LPA's observed (3) clients in the common area and was advised that (1) client (C1) was attending day program and (1) client (C2) was staying with their conservator.

During today's inspection, LPA"s briefly discussed incident report received on Friday, 3/31/23, pertaining to clients C1 and C2 and obtained copies of documentation from both files. LPA's and ACRC representative and Administrator toured the interior of the facility and observed it to be clean, in good repair and odor free.
LPA's observed 2+day perishable and 7+day non-perishable supply of food on hand.

LPA's did not observe any immediate health and safety risk or personal rights violation to clients in care.

LPA's will return at a future time if warranted. There are no citations issued in today's report.

Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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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