502701283-11-21-2023-27-AS-RCAL-CXSSWX-20231121131501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 502701283
Report Date: 11/21/2023
Date Signed: 11/21/2023 01:18:05 PM

Document Has Been Signed on 11/21/2023 01:18 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SUNNYSIDE SENIOR LIVING INC		FACILITY NUMBER:	502701283
ADMINISTRATOR:	ELL, NICOLE		FACILITY TYPE:	740
ADDRESS:	120 2OTH CENTURY BLVD		TELEPHONE:	(209) 668-8014
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95380
CAPACITY:	56	CENSUS: 39	DATE:	11/21/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nicole Ell, Administrator		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/21/2023, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a Pre-Licensing Visit. LPA met with applicant Nicole Ell, Administrator and Albert Ell, Vice President and explained the purpose of the visit. The purpose of this Pre-Licensing Visit is due to a change of ownership. Current census is 39 residents at this time. The facility has a fire clearance for 40 non-ambulatory and 16 bedridden residents. LPA observed the secure file room where staff and resident files are kept locked in a file cabinet. A tour of the facility was conducted. It was observed that a new resident in a shared bedroom did not have a chest of drawers yet but her family would be bringing one for her. The facility stated that they will provide a bed, night stand, chair, lighting and drawers if the resident is not able to provide it for themselves. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. The refrigerator had a temperature of 39 degrees Fahrenheit and the freezer -4.6 degree Fahrenheit. A tour of the pantry was conducted where the facility holds extra non-perishable food supplies. The facility regularly rotates out emergency food supplies to maintain freshness.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNNYSIDE SENIOR LIVING INC	FACILITY NUMBER: 502701283
	VISIT DATE: 11/21/2023

NARRATIVE

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LPA observed a locked centralized stored medication cabinet located in the Med Tech office near the front of the building. The MAR's log book and the locked narcotics box was observed as well. A First Aid Kit was present and contained all of the required components. A fire extinguisher was located in the living room and was last serviced on 01/26/2023.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. An additional emergency food supply was observed in an outside shed.
A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents .

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited during visit. During today's visit Component III was done with Nicole Ell. An exit interview was conducted with the Administrator and a report left.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC809 (FAS) - (06/04)

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