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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003658
Report Date: 01/10/2023
Date Signed: 01/10/2023 04:43:40 PM

Document Has Been Signed on 01/10/2023 04:43 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 RESIDENTIAL CARE SERVICES, INC. (#3)FACILITY NUMBER:
347003658
ADMINISTRATOR:DICKEY, MAYEFACILITY TYPE:
735
ADDRESS:7601 VAN MAREN LANETELEPHONE:
(916) 725-6647
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
01/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Elvie Nitollama, DSP TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Elvie Nitollama, DSP and explained purpose of inspection. LPA observed Milagros Andres, DSP, also working at the time of the inspection. Aurelio Andres, DSP, was present but was on his day off. LPA spoke with Administraor, Maye Dickey, by phone. Prior to initiating today's inspection, LPA completed required COVID-19 protocols and 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: surgical mask. The facility is a licensed 4F home that is vendorized through Alta California Regional Center. There are (6) clients who reside at the home. LPA observed (4) clients at the start of the inspection and (1) client return later from day program. (1) client remained outside the facility while working a job.

LPA and DSP toured the interior and exterior of the facility including the common areas, (4) client bedrooms, (2) bathrooms, kitchen, and laundry area. LPA observed the home 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 throughout as well as other required postings, including House Rules and personal rights. Inside temperature observed to be 70* F. Fire extinguisher last serviced 8/30/2022. Facility conducts monthly fire drills- documentation observed. The facility has a large back yard area with seating. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathrooms. LPA observed grab bars and non-skid flooring in the bathrooms and sufficient PPE supply on hand.
Adult Residential Certificate #6010165735-posted exp 11/25/22- Administrator stated she submitted renewal documentation in October 2022. Discussed resident and staff vaccination status and visitation protocols.

There are no deficiencies observed today. Copy of LIC500 and LIC308 requested by 1/17/23.
Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023
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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