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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001957
Report Date: 01/25/2024
Date Signed: 01/25/2024 03:23:49 PM


Document Has Been Signed on 01/25/2024 03:23 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 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: 60DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jonathon Moore, Executive DirectorTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 1/25/24 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed four (4) apartments in Assisted Living, two (2) apartments in Memory Care, and three (3) common area bathrooms. LPA conducted interviews with four (4) residents and four (4) staff during inspection. LPA observed apartments to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 116.6 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed the outdoor area for Assisted Living and Memory Care to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. LPA observed the perimeter of the care home to be free of clutter and debris. LPA ensured that delayed egress in Memory Care was operational. Smoke detectors and carbon monoxide detectors are hard wired in the care home. Fire extinguishers are maintained and ready for emergency use. LPA reviewed three (3) staff files during visit.

As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to finish reviewing files and complete annual inspection.

Exit interview conducted and copy of report given at the conclusion of this visit.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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