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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001957
Report Date: 12/10/2021
Date Signed: 12/10/2021 11:51:44 AM

COMPREHENSIVE INSPECTION
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 ASSISTED LIVING OF FAIR OAKSFACILITY NUMBER:
347001957
ADMINISTRATOR:WHALEY, LYNDEEFACILITY TYPE:
740
ADDRESS:4820 HAZEL AVETELEPHONE:
(916) 863-1499
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:74CENSUS: 56DATE:
12/10/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Lyndee Whaley, Administrator TIME COMPLETED:
11:50 AM
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Licensing Program Analysts (LPA's) Sabrina Calzada and Cassie Yang, arrived unannounced to conduct a required annual. LPA met with Lyndee Whaley, Administrator and explained purpose of inspection. LPA's were not able to choose a required annual as an option (only annual continuation), so the inspection domain tool was not accessible. LPA's completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA's were screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn surgical mask. The facility is approved for (74) residents and has a hospice waiver for (14). The facility has an approved mitigation plan.

LPA's and Administrator toured the interior of the facility including the Assisted Living Unit, Memory Care Unit, main kitchen, medication room and common areas including the lobby area. In areas toured, LPA's observed the facility to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters, sanitizer and PPE throughout the building. LPA's observed paper towels, soap and hand-washing poster in restrooms and the facility will ensure all restrooms have a trash can with lid. Inside temperature was observed to be 76* F. Fire extinguishers last serviced 9/23/2021. LPA's observed 2+day perishable and 7+day non-perishable food and all sharps and toxins to be locked. LPA's and and Administrator discussed the vaccination status of residents/staff as well as visitation protocols per PIN 21-40. Administrator to post signage a the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry.

LPA requested an updated copy of LIC308, current liability insurance during today's inspection by 12/17/2021.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator who was informed that a subsequent annual inspection could be conducted on/around 3/29/2022.


SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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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