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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004534
Report Date: 08/25/2023
Date Signed: 08/25/2023 03:32:22 PM


Document Has Been Signed on 08/25/2023 03:32 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. #4FACILITY NUMBER:
347004534
ADMINISTRATOR:MAYE DICKEYFACILITY TYPE:
740
ADDRESS:7233 CAMEL ROCK WAYTELEPHONE:
(916) 725-6647
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:4CENSUS: 3DATE:
08/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Elizabeth Lucas, DSPTIME COMPLETED:
03:30 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 Teodoro Lucas, DSP, and explained purpose of inspection. There were (3) clients present and who currently live at the home. The facility is an Residential Care Facility for the Elderly (level 4I home) that is vendorized through Alta California Regional Center. Administrator, Maye Dickey, arrived around 1:30 pm.

LPA and DSP toured the interior and exterior of the facility including the common areas, (4) private client bedrooms, (2) bathrooms, kitchen, (1) staff room, activity room/sun room, laundry area and outside 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 (Maye Dickey) certificate # 6010165740- exp 2/3/24 and Co-Administrator (Jasmine Cailing) certificate #6003409735 exp 6/20/23 posted. Fire extinguisher just serviced 8/23/23. Facility conducts monthly disaster drills. There is a back yard area with covered seating and (2) unlocked exit gates and gardens. There are no pools. LPA observed locked toxins and sharps 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 supplies. LPA observed soap, trash cans with lids and hand-washing posters in the bathroom. LPA observed sufficient towels, linens and blankets and clients are provided with paper towels for hand-washing. LPA observed a completed First-Aid kit and reviewed the Infection Control Plan and found it to be comprehensive. Hot water temperature measured 105*F in the kitchen. Inside temperature measured 72*F. LPA reviewed (3) of (3) staff files- First Aid/CPR and training is current. LPA reviewed (2) of (3) client files and found them to contain current documentation. Medications were reviewed for (1) client- orders match medications being administered and documentation is current. LPA reviewed P&I for (3) clients - records match funds on hand. LPA requested updated LIC308, LIC610E and copy of liability insurance be provided to CCLD by 9/1/23. There are no deficiencies issued in today's report. Exit interview. Copy of report provided to Co-Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2023
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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