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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700890
Report Date: 11/06/2024
Date Signed: 11/06/2024 12:09:09 PM

Document Has Been Signed on 11/06/2024 12:09 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNGARDEN VILLA IIIFACILITY NUMBER:
342700890
ADMINISTRATOR/
DIRECTOR:
ARMINDER TAKHARFACILITY TYPE:
740
ADDRESS:8371 BUNCHBERRY CT.TELEPHONE:
(916) 560-8849
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Arminder Takhar, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection LPA met with Diwata Vallejo, caregiver. Administrator Designee, Russelle Robinson, who is also a certified Administrator, arrived shortly. LPA explained purpose of inspection. The facility is licensed for (6) non-ambulatory residents, (1) of whom may bedridden, and has a hospice waiver for (4). There are currently (5) residents and (2) residents are under hospice care. LPA observed (2) residents in the common area and (3) in their rooms at the start of the inspection.

LPA and the Administrator Designee toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with half bath, (2) full bathrooms, kitchen, staff room and locked laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. 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. There are sufficient linens/towels/blankets/PPE, and the inside temperature measured 73*F. .Fire extinguisher was last serviced 6/19/24, and the facility conducts quarterly fire drills- last drill conducted 8/15/24. LPA observed (2) unlocked gates from the inside back patio. There is sufficient outdoor space with seating and shade, and there are not any pools/ponds.

LPA reviewed (2) resident files and found them to be organized, complete and current. LPA reviewed ordered medications for (1) residents to those being administered and found no discrepancies. (2) staff files were reviewed- staff is fingerprint cleared, associated and has current First Aid/CPR, and has completed the required training in last 12 months, through an approved on-line provider. Administrator certificate #605337740- exp 6/14/24- pending renewal. RCFE Adm Designee certificate # 6056696740-exp 12/10/2024. An updated copy of current liability insurance was obtained. LPA obtained an updated LIC500 and requested a LIC308 by 11/13/24. There are no deficiencies issued.
Exit interview with Administrator. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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