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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003658
Report Date: 01/14/2025
Date Signed: 01/14/2025 05:19:32 PM

Document Has Been Signed on 01/14/2025 05:19 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 RESIDENTIAL CARE SERVICES, INC. (#3)FACILITY NUMBER:
347003658
ADMINISTRATOR/
DIRECTOR:		DICKEY, MAYEFACILITY TYPE:
735
ADDRESS:7601 VAN MAREN LANETELEPHONE:
(916) 910-9583
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Elvie Nitollama, Lead DSP TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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LPA Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Elvie Nitollama, Lead DSP. Also present were DSP's, Milagros Andres and Aurelio Andres.
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 (2) clients at the start of the inspection and (4) clients return later from day program.

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. Inside temperature observed to be 70* F. Fire extinguisher last serviced 7/31/24. Facility conducts monthly fire drills- last drill Dec 2024. Smoke/monoxide alarms work. The facility has a large back yard area with seating and a garden. LPA observed locked toxins and sharps in the kitchen and sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food. Medications are secured near the kitchen. Bathrooms have all required supplies and there are sufficient PPE products, linens, towels and blankets. Hot water measured 110*F in the kitchen. Required postings up including resident roster, resident rights, House Rules and ARF Admin certificate #7036197735- pending renewal (exp 7/25/24). Plan, House Rules and ARF Admin certificate #6010165735- exp 11/25/24. Updated land line obtained. There are (2) unlocked gates. The Infection Control Plan was reviewed and found to be comprehensive with multiple pages and different illnesses addressed. Page printed so it can signed each time it's reviewed.

LPA reviewed (5) of (5) staff files and (2) client- files were organized and complete with current documentation. First Aid/CPR is current as well as annual training, including for medications. All staff is cleared/associated. Medications were reviewed for (1) client- no errors noted. Medication documentation is very complete and current. There are no deficiencies observed today. Copy of LIC500 and LIC308 requested by 1/21/25. Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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