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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002740
Report Date: 08/31/2021
Date Signed: 08/31/2021 10:14:18 AM

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 HOMESFACILITY NUMBER:
397002740
ADMINISTRATOR:ELIZABETH ABESAFACILITY TYPE:
740
ADDRESS:8100 S. BRIGHT ROADTELEPHONE:
(209) 234-2550
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:15CENSUS: 10DATE:
08/31/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Elizabeth AbesaTIME COMPLETED:
10:30 AM
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On 8/31/2021 at 9:45am, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a POC visit. LPA met with Administrator and explained the purpose of today’s visit. Prior to today's visit LPA contacted Administrator regarding facility risk assessment questions. Administrator confirmed no staff or residents have experienced symptoms within the last 10 days. LPA was allowed entry into the facility, current census is 10.

Deficiency cited under Title 22 87303(c) during inspection on 6/03/2021 included missing window screens in resident rooms, common area, and kitchen. Licensee complied with the terms of the POC by approved extension of POC due date. POC letter provided during today's inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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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