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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005180
Report Date: 05/28/2021
Date Signed: 05/28/2021 03:11:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SUNRISE ASSISTED LIVING OF SACRAMENTOFACILITY NUMBER:
347005180
ADMINISTRATOR:SARA WEININGERFACILITY TYPE:
740
ADDRESS:345 MUNROE STTELEPHONE:
(916) 486-0200
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:70CENSUS: 54DATE:
05/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Sara WeiningerTIME COMPLETED:
03:30 PM
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On 5/28/21 at 1:00pm Licensing Program Analyst (LPA) Kevin Gould arrived at Sunrise Assisted Living of Sacramento (RCFE) for the purpose of conducting an unannounced required annual inspection. LPA wet with Administrator Sara Weininger and together toured the facility and reviewed the facility's infection control measures specific to COVID 19.

The facility is a two story large residential community serving both assisted living and memory care residents. Current census is 54. The memory care unit is located on the first floor, consists of 18 bedrooms and utilizes delayed egress doors. The assisted living unit is primarily on the second floor and consists of 34 bedrooms. LPA and Administrator together toured the entire facility including assisted living unit, memory care unit, resident bedrooms, resident bathrooms, medication room, medication cart, dining room/Bistro area, kitchen, laundry room and outside perimeter of the care community. LPA observed the common areas of the community to be free of odor and clean. LPA tested the hot water in a vacant resident room and recorded a temperature of 113* F. Sufficient furniture and lighting was observed throughout the facility and inside resident rooms. There are no bodies of water present in the facility. LPA inspected the kitchen and dining room area and observed a sufficient supply of non-perishable and perishable food available on hand, while proper food preparation and storage was observed as well. The refrigerator and freezer were observed by the LPA to be the required temperatures. There are currently 7 residents on hospice.

Smoke detectors are hard wired, and fire extinguishers are current and in compliance with the fire safety code. LPA observed that centrally stored medications, toxins, knives, and sharp objects are kept locked and inaccessible to residents. First aid kits are stored in the medication room and the kitchen.

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SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE ASSISTED LIVING OF SACRAMENTO
FACILITY NUMBER: 347005180
VISIT DATE: 05/28/2021
NARRATIVE
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LPA obtained the following documents for facility file:
LIC 308
LIC 500
LIC 610E
Copy of administrator certificate

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed or cited during this inspection. Exit interview was conducted with the Administrator and a copy of this report was left at the facility.

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SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
LIC809 (FAS) - (06/04)
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