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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700890
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:50:46 PM

Document Has Been Signed on 11/17/2022 04:50 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUNGARDEN VILLA IIIFACILITY NUMBER:
342700890
ADMINISTRATOR:SINGH, JASMEETFACILITY TYPE:
740
ADDRESS:8371 BUNCHBERRY CT.TELEPHONE:
(916) 560-8849
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Aizza Gonzales, Asst. Administrator and Russelle Robinson, Administrator Designee TIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Russelle Robinson, Administrator Designee,and Aizza Gonzales, Asst. Administrator. LPA observed a second caregiver, Diwata Valejo also present. LPA observed (2) residents in the common area watching television and (4) residents to be in their rooms at the start of the inspection. Currently, there is (1) resident on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Prior to initiating today's inspection, LPA completed required COVID-19 protocols, and was screened per Covid-19 precautionary measures upon entering the facility. LPA wore a surgical mask.

LPA and toured the Administrator Designee toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with bathroom, (2) separate full bathrooms, kitchen, staff room and locked laundry area. The upstairs area is not used by residents. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and medications to be secured nearby. LPA observed the inside temperature to be 76*F. Fire extinguisher was last serviced 6/23/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols. Administrator indicated there will be an on-site flu clinic later this month as a booster clinic was completed in October 2022..LPA observed multiple Covid posters and resources posted throughout as well as other required postings. LPA observed (2) unlocked gates from the inside back patio. All exit doors have alarms.

LPA obtained an updated copy of LIC500, LIC308 and current liability insurance during today's inspection.
There are no deficiencies issued during today's inspection.
Exit interview with Administrator. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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