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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920051
Report Date: 08/30/2024
Date Signed: 08/30/2024 11:29:21 AM

Document Has Been Signed on 08/30/2024 11:29 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR/
DIRECTOR:		PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1031 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 199CENSUS: 107DATE:
08/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Carol PickardTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 8/30/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit regarding an unexpected resident death and met with Senior Executive Director (ED), Carol Pickard and Program Director (PD), Liza Spencer, LVN.

On 8/29/24, the department received a death notification regarding R1, who passed away on 8/27/24.

LPA, at todays visit, received and reviewed R1's LIC 602, care plan, medication administration records and call pendant records.

R1 was found to have multiple chronic illnesses. R1 had had a medical appointment the day prior with no noted new health concerns. R1 was last observed the evening before. R1 had not made any calls for assistance by pendant on the overnight of 8/26-8/27/24.
When 8 AM staff assistance was provided, R1 was found to be unresponsive and 9-1-1 was called.

At this time, R1 appears to have passed away due to natural causes and appeared to have received the necessary level of care and supervision for identified needs.


As a result of today’s inspection, no deficiencies were noted.


Report reviewed. Copy of report and appeal rights provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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