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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701283
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:07:30 PM

Document Has Been Signed on 11/26/2024 03:07 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 INCFACILITY NUMBER:
502701283
ADMINISTRATOR/
DIRECTOR:
MELISSA BRICHKAFACILITY TYPE:
740
ADDRESS:120 2OTH CENTURY BLVDTELEPHONE:
(209) 614-5171
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 56CENSUS: 38DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Melissa Brichka, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived at the facility to conduct an unannounced annual inspection on 11/26/2024.  LPA met with Melissa Brichka, Administrator and explained the purpose of the visit. Staff Dawn Pero and Krystal Calderon assisted with today’s visit and were found to be associated to the facility.

LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a two story building licensed to service the elderly and those with dementia, age 60 and over or 56 non-ambulatory residents of which 16 may be bedridden. The first floor is approved for bedridden and a waiver was granted for hospice care for 16.

LPA Campbell observed the facility to be free of odor, clean and in good repair. LPA Campbell observed 56 beds and 28 rooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. Fire extinguishers were last inspected on 01/02/2024. The temperature for the refrigerator was measured at 33 degrees Fahrenheit and the freezer was measured at -6 degrees Fahrenheit.

LPA Campbell observed sufficient seven-day non-perishable and two-day perishable food supplies. RCFE hot water temperatures are to be 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). Hot water was measured at 130 degrees Fahrenheit in a resident's bathroom was found to be accompanied by a sign warning of hot water as required. Fire extinguishers, smoke and carbon monoxide detectors are in good repair as documented in fire drill logs. A fire drill log was reviewed by LPA Campbell. Per documentation, a monthly fire drill was conducted successfully and staff reviewed use of the fire extinguishers.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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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: 11/26/2024
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Facility thermostat observed at 74 degrees Fahrenheit. LPA Campbell requested client and staff files for review. LPA reviewed 4 resident files and 4 staff files. Resident files were observed to be complete. Toxins were made inaccessible to clients in care. Toxins were stored in the laundry room and locked storage closets. The laundry room is locked when staff must leave it unattended.

The following documents will be emailed to LPA Campbell (Renee.Campbell@dss.ca.gov) by 12/05/2024 by 12:00 PM :
(1) LIC 308 Designation of Administrative Responsibility
(2) LIC 500 Personnel Report
(3) Copy of Administrator Certificate   
(4) LIC 610 Emergency Disaster Plan

Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. A copy of this report was provided to the facility
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
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