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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004534
Report Date: 09/23/2022
Date Signed: 09/23/2022 04:03:44 PM


Document Has Been Signed on 09/23/2022 04:03 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. #4FACILITY NUMBER:
347004534
ADMINISTRATOR:MAYE DICKEYFACILITY TYPE:
740
ADDRESS:7233 CAMEL ROCK WAYTELEPHONE:
(916) 725-6647
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:4CENSUS: 4DATE:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Elizabeth Lucas, DSPTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Elizabeth Lucas, DSP, and explained purpose of inspection. Nida Cailing, House Manager and Lita Cailing, Co-Administrator,, arrived at approximately 2:30 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA 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 an RCFE (level 4I home) that is vendorized through Alta California Regional Center. There are (4) clients who reside at the home. LPA observed (4) clients in the facility and was advised (1) client is on hospice.

LPA and DSP toured the interior and exterior of the facility including the common areas, (4) client bedrooms, (2) bathrooms, kitchen, laundry area and enclosed patio. 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. Administrator certificate #6010165740- exp 2/3/2024 and Certificate #6003409735- exp 6/20/23. Inside temperature was observed to be 73* F. Fire extinguisher last serviced 8/30/2022. Facility conducts monthly fire drills, at different hours of the day. The facility has a large back yard area with seating/garden. There are no pools/ponds. Each resident room has an exit door with alarms. LPA observed locked toxins and sharps to be in the laundry area and locked medications in a separate cabinet. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathroom. Discussed resident and staff vaccination status and eligibility for booster shot. LPA provided booster flyer. Discussed visitation protocols. LPA observed organized binders with staff and resident documentation as well as several binders containing the Covid-19 Mitigation Plan, Monkey Pox and Infection Control plans. LPA requested updated copy of LIC610E, LIC308 and current copy of liability insurance be faxed by 9/30/22.
There were no deficiencies observed. Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022
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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