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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701283
Report Date: 05/24/2024
Date Signed: 05/24/2024 10:45:11 AM


Document Has Been Signed on 05/24/2024 10:45 AM - 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 INCFACILITY NUMBER:
502701283
ADMINISTRATOR:ELL, NICOLEFACILITY TYPE:
740
ADDRESS:120 2OTH CENTURY BLVDTELEPHONE:
(209) 614-5171
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:56CENSUS: 42DATE:
05/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Krystal Calderon, Administrative AssistantTIME COMPLETED:
11:00 AM
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On 05/24/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced regarding closure of the facility under the former owner. LPA Campbell was met by Dawn Pero, Care Coordinator and Krystal Calderon, Administrative Assistant and explained the purpose of the visit.

As LPA Campbell drove into the driveway of the facility, the new sign bearing the name Sunnyside Senior Living was observed. Upon entry, LPA observed clients eating breakfast and being assisted by staff. Residents were observed socializing and watching TV as well. During the visit, staff conducted a Bingo game for the residents. LPA Campbell confirmed that the current owner and facility Administrator for Sunnyside Senior Living was Nicole Ell as recorded in FAS. It was then found that the former facility owners (under the former name of St. Francis Assisted Care) had not completed their closure process. When asked, Dawn Pero stated she had the contact information for the former owners of St. Francis Assisted Care. LPA Campbell recorded the information and prepared a forfeiture letter to be mailed to the former owners via certified mail from the regional office. Form 9104 was also prepared so that closure could be processed.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's visit. An exit interview was conducted, and a copy of this report was left at the facility. 
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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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