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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004635
Report Date: 11/07/2024
Date Signed: 11/07/2024 05:15:33 PM

Document Has Been Signed on 11/07/2024 05:15 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:SUNFLOWER'S HOMEFACILITY NUMBER:
347004635
ADMINISTRATOR/
DIRECTOR:
MITITI, MELANIAFACILITY TYPE:
740
ADDRESS:8429 SUNRISE BLVDTELEPHONE:
(916) 560-3699
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lucian Mititi, Administrator DesigneeTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Administrator Designee, Lucian Mititti, stating the reason for today's inspection. LPA observed the fire department to arrive at the same time and was advised the facility had just called due to resident (R1) showing a change in condition. (R1) was taken to the hospital. LPA observed (1) resident in the common area watching television and (3) residents in their rooms and was advised there is another resident who is currently participating in physical therapy at a rehab facility. Also present were caregivers, Sharay Burke and Larisa Vornices. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Currently there is (1) resident under hospice care. The upstairs area is not used by residents.

LPA and Administrator Designee toured the interior and exterior of the facility including the common areas, (6) resident bedrooms (w/half bathroom each), (2) full bathrooms, kitchen, office, large activity room, staff rooms (2) and laundry area. LPA observed the facility to be clean, in good repair and odor-free, and observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels. There are hand-washing posters at each sink. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are secured in the kitchen, and resident medications are secured in the office area. The inside temperature measured 73*F and the hot water measured 113*F in a resident bathroom. There are sufficient linens, towels, blankets and PPE supplies, as well as a complete First Aid kit. Smoke/monoxide alarms are working and the fire extinguisher was last serviced 3/11/24. All required posting are visible in the common area. Administrator RCFE certificate #6019173740 is pending renewal. There are cameras in the common area. The facility conducts a variety of activities, including cooking, crafts, holiday celebrations, movies.

LPA reviewed files and medications for (2) residents. Files and documentation were organized and medications being administered match orders. LPA reviewed (3) staff files. All staff are cleared/associated and staff is completing required training, including First Aid/CPR. Updated insurance information obtained. LPA requested a current LIC500 and LIC308 by 11/14/24. There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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