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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700891
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:17:47 PM

Document Has Been Signed on 11/06/2024 03:17 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 IFACILITY NUMBER:
342700891
ADMINISTRATOR/
DIRECTOR:
TAKHAR, ARMINDERFACILITY TYPE:
740
ADDRESS:7523 FIREWEED CIRCLETELEPHONE:
(916) 560-3171
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Russelle Robinson, Administrator Designee TIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Eva Tajiti, caregiver. Administrator Designee, Russelle Robinson, 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 (3). There are currently (6) residents and (0) residents are under hospice care. LPA observed (2) residents in the common area, and (3) residents in their rooms at the start of the inspection. (1) resident was sent to the hospital today.

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 are locked in the office. 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. 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. Hot water measured 118*F in the kitchen, and there is a complete First Aid kit. Each exit door has a working alarm. All required postings are in the common area.
(3) resident files were reviewed and found to be complete with current documentation. Medications were reviewed for (2) residents- orders match medications being administered. (2) staff files were reviewed. Both staff have documentation of completing initial or ongoing required training, including First Aid/CPR. Facility will organize vehicle maintenance records in a binder. LPA observed valid current insurance and registration. 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 requested an updated LIC500 and 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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