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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004635
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:13:30 PM


Document Has Been Signed on 11/08/2023 01:13 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:MITITI, MELANIAFACILITY TYPE:
740
ADDRESS:8429 SUNRISE BLVDTELEPHONE:
(916) 284-7360
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
11/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Melania Mititi, Administrator TIME COMPLETED:
01:15 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 then met with Melania Mititti, Administrator, and Lucian Mititti, Co-Administrator. LPA observed (3) residents in the common area watching television and (3) residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently there are (0) residents under hospice care.

LPA and Administrator, Melania, toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with half bathroom each, (2) separate full bathrooms, kitchen, office, large activity room, staff rooms (2) 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. There are hand-washing and cough etiquette posters in the kitchen. 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. Resident medications are secured in the office area and only prepared for the current day. The inside temperature was 75*F and the hot water measured 108*F in a resident bathroom. LPA observed the hot water temperature to be set at 115*F on the inside thermostat. Fire extinguisher was last serviced 3/24/23 and is tested monthly and documented. Smoke/monoxide alarms are in working order and the fire door closes automatically when the alarm is activated. The facility conducts monthly fire drills -staff and residents will practice exiting the facility from different approved locations. LPA observed sufficient linens and PPE supplies. The facility conducts a variety of activities, including cooking, crafts, holiday celebrations, movies. LPA reviewed (3) resident files and found them to contain current documentation. Medications were reviewed for these (3) residents- medications are being administered as ordered and accurate records are maintained for both scheduled and PRN medications.
cont on 809C-1...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNFLOWER'S HOME
FACILITY NUMBER: 347004635
VISIT DATE: 11/08/2023
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809C-1.. LPA reviewed (3) staff files. All staff are cleared and associated and have completed or in the process of completing required ongoing training. First Aid/CPR is current also.

There are no pools or bodies of water. LPA observed an open area to exit from the backyard and there are no locked gates. There is a complete First Aid kit on site. LPA observed a current copy of liability insurance.

LPA observed Administrator certificates (3) posted in the office for Melania Mititii, Lucian Mititi and Christian Mititi.

There are no changes to the LIC308 or LIC500.

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: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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