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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004346
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:18:23 PM


Document Has Been Signed on 07/06/2023 02:18 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 CARMICHAELFACILITY NUMBER:
347004346
ADMINISTRATOR:TANIA LANGLANDFACILITY TYPE:
740
ADDRESS:5451 FAIR OAKS BLVDTELEPHONE:
(916) 485-4500
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:66CENSUS: 52DATE:
07/06/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Tania LanglandTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 7/6/23 to conduct a Required-1 Year Inspection utilizing CARE inspection tool. LPA met with the Executive Director and explained the purpose of the visit.

LPA toured the interior of the facility together with Executive Director to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, 6 resident bedrooms as well as the rest of the physical plant. In the areas toured no immediate health, safety, or personal rights violations were observed. The residence was found to be clean, safe, sanitary and in good condition. Water temperature checked and water maintained in required range. Stairwells have required evac chair.
Facility has required food supplies. There are appropriate staff present to meet the needs of residents.

LPA reviewed resident files and staff files. 6 Resident files reviewed are complete and current for documents checked. 7 Staff files reviewed were complete for documents checked.

LPA received a copy of liability insurance.
As a result of this inspection, no deficiencies are noted.
Report reviewed with Tania Langland. Copy of this report.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
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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