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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003658
Report Date: 12/16/2025
Date Signed: 12/16/2025 04:37:05 PM

Document Has Been Signed on 12/16/2025 04:37 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:
12/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Elvie Nitollama, Lead DSPTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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LPA Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with DSP's, Milagros "Mila" Andres and Aurelio Andres. Elvie Nitollama, Lead DSP, arrived around 2:00 pm. The facility is a licensed Level 5 home that is vendorized through Alta California Regional Center. There are (6) clients who reside at the home. (4) returned from day program and (2) clients returned from the doctor's office. The administrator, Maye Dickey, arrived around 3:00 pm.

LPA and DSP's toured the interior/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 7/17/25. Fire clearance approved for (2) ambulatory rooms and (2) non-ambulatory rooms. Clients are appropriately placed. Toxins and sharps are locked in the kitchen and medications are locked in a nearby cabinet. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food. Bathrooms have all required supplies. There are sufficient PPE products, linens, towels and blankets. Hot water measured 110.5*F in the kitchen. Required postings are visible in the common area, including the resident roster, resident rights, House Rules and ARF Admin certificate #7036197735- (exp 11/25/26) and ARF Admin certificate #7000814735 (exp 6/20/27). All resident rooms have a lock that can be opened by a key or code. The facility has a large back yard area with seating and a small garden. There are (2) unlocked exit gates and locked storage sheds with supplies.

LPA reviewed (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 and documentation is very complete . P&I were reviewed for (2) clients- records match funds on hand. Each room is very organized and neat.
There are no deficiencies observed today. Exit interview. Copy of report left at facility.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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