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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004534
Report Date: 10/04/2024
Date Signed: 10/07/2024 08:26:17 AM


Document Has Been Signed on 10/07/2024 08:26 AM - 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) 560-3525
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:4CENSUS: 4DATE:
10/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Elizabeth Lucas, DSPTIME COMPLETED:
05:25 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 (4) 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. House Manager, Jasmine Fournier, arrived 4:00 pm. There is an approved hospice waiver for (1)- currently no resident is on hospice.

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. Administrator (Maye Dickey) certificate # 7036197740 is pending. Fire extinguisher just serviced 7/31/24, and the facility conducts monthly disaster drills- posted. Smoke/monoxide alarms are in working order.

There is a back yard area with covered seating and (2) unlocked exit gates and gardens. There are locked toxins and sharps in the laundry area and locked medications in a separate cabinet. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food and 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. There is a complete First-Aid kit. Hot water temperature measured 108*F in the kitchen. Inside temperature measured 75*F. LPA reviewed (3) of (3) staff files- First Aid/CPR and annual training is current. LPA reviewed (2) client files and found them to be organized and contain current documentation. Medications were reviewed for (1) client- orders match medications being administered and documentation is complete and current.

LPA requested updated LIC308, LIC610E and copy of liability insurance be provided to CCLD by 10/18/24. There are no deficiencies issued in today's report. A Technical Advisory note was issued.

Exit interview. Copy of report to be emailed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024
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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