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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004635
Report Date: 11/22/2022
Date Signed: 11/22/2022 01:54:52 PM


Document Has Been Signed on 11/22/2022 01:54 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:SUNFLOWER'S HOMEFACILITY NUMBER:
347004635
ADMINISTRATOR:MITITI, MELANIAFACILITY TYPE:
740
ADDRESS:8429 SUNRISE BLVDTELEPHONE:
(916) 284-7360
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Melania Mititi, Administrator TIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Ingrid Henry, caregiver and explained purpose of inspection. LPA met with Melania Mititti, Administrator, and Christian Mititti, Assistant staff. LPA observed Lucian Mititti, Co-Administrator, who assists with medication. LPA observed (1) resident in the common area watching television and (4) residents to be in their rooms at the start of the inspection. LPA was informed that (1) resident was at a doctor's appointment. Currently, there is (1) resident on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Prior to initiating today's inspection, LPA completed required COVID-19 protocols, and was screened per Covid-19 precautionary measures upon entering the facility. LPA wore a surgical mask.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with half bathroom each, (2) separate full bathrooms, kitchen, large activity room, staff room and laundry area. The upstairs area is not used by residents. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and medications to be secured in the office area. LPA observed the inside temperature to be 74*F. Fire extinguisher was last serviced 3/15/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols. LPA provided booster flyer. LPA observed all required posting throughout - Administrator to post additional Covid posters. There are no pools or bodies of water. LPA observed an open area to exit from the backyard. LPA observed sufficient PPE, incontinent and paper supplies on hand. LPA observed Administrator certificates (2) posted in the office for Melania Mititii and Christian Mititi.

LPA requested an updated copy of LIC500, LIC308 and current liability insurance by 11/30/22.
There are no deficiencies issued during today's inspection.
Exit interview with Administrator. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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