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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001957
Report Date: 03/28/2022
Date Signed: 03/28/2022 01:09:25 PM


Document Has Been Signed on 03/28/2022 01:09 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 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:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Joli Defazio, Marketing Director and Katie Nelson, Resident Care Coordinator TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Joli Defazio, Marketing Director, and explained purpose of inspection. Before today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was 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: KN95 mask. The facility is licensed for (74) residents and has a hospice waiver for (14). There are (7) residents currently on hospice.

LPA and Marketing Director toured the interior of the facility including the Assisted Living Unit, Memory Care Unit, laundry and maintenance areas, staff break room, guest restrooms, bathtique, and common areas including the lobby area. In areas toured, LPA 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 paper towels, soap and sanitizer in restrooms and trash cans (5) with a lid will arrive tomorrow. Facility to re-post hand-washing posters at every sink, including staff break room and restrooms. Inside temperature was observed to be 73* F. Fire extinguishers last serviced 9/23/2021. Staff and resident vaccination status was discussed as well as visitation protocols per PIN 22-07 issued 2/7/2022. Vaccination cards and test results are inputted into the Point Click Care system. LPA observed all staff to be wearing surgical masks. PPE supplies are sufficient as well as Covid testing supplies.

LPA requested an updated copy current liability insurance during today's inspection by 3/31/2022.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2022
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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