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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700897
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:55:09 PM

Document Has Been Signed on 10/09/2024 04:55 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 IIFACILITY NUMBER:
342700897
ADMINISTRATOR/
DIRECTOR:		ROBINSON, CURTISFACILITY TYPE:
740
ADDRESS:8381 BUNCHBERRY CTTELEPHONE:
(916) 560-3162
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Russelle Robinson, Administrator DesigneeTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection LPA met with Jason Geron, caregiver, and Nonadel Soriano, caregiver. Administrator Designee, Russelle Robinson, who is also a certified Administrator, arrived at 2:30 pm. 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 (1) resident under hospice care. LPA observed (1) resident to be in the common area and (5) in their rooms at the start of the inspection. (2) nurses from an outside company were attending to residents also.

LPA toured 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. 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. The inside temperature to be 77*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 and a third locked gate for the gated pool. Administrator certificate #605337740- exp 6/14/24- pending renewal. RCFE Adm Designee certificate # 6056696740-exp 12/10/2024.

LPA reviewed (3) resident files and found them to be organized and contain current paperwork. 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.
There are no deficiencies issued, but there is a Technical Advisory note being issued.

Exit interview with Administrator. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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