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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701147
Report Date: 03/10/2025
Date Signed: 03/10/2025 03:55:41 PM

Document Has Been Signed on 03/10/2025 03:55 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNNY SIDE CARE HOMEFACILITY NUMBER:
342701147
ADMINISTRATOR/
DIRECTOR:		MASSAQUOI, MOHAMEDFACILITY TYPE:
740
ADDRESS:8436 KEUSMAN ST.TELEPHONE:
(916) 897-8347
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 5DATE:
03/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Mohamed MassaquoiTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a plan of corrections visit. LPA Moleski spoke with facility administrator Mohamed Massaquoi over the phone and explained the purpose of the visit. Massaquoi said that staff member Sedella Longmore could sign this report in his absence.

LPA Moleski conducted an annual inspection at this facility on 03/03/2025. During that visit, LPA Moleski issued four Type A citations which required immediate correction. During that visit, Massaquoi agreed to provide plans of correction to LPA Moleski by 03/04/2025. Massaquoi followed up on one citation regarding fire clearance, but did not provide anything further to LPA Moleski until 03/10/2025. On this date, Massaquoi provided LPA Moleski with training records regarding a citation for accessible cleaning solutions dated 03/04/2025.

However, a staff member, who should have been associated to this facility's roster by 03/04/2025 was not associated until 03/10/2025. Additionally, Massaquoi had agreed to send LPA Moleski a photograph of a lowered water temperature reading by 03/04/2025, but on 03/10/2025, Massaquoi sent LPA Moleski a photograph of a water temperature reading of 123 degrees, which is still above the 120-degree threshold required by 22 CCR.

LPA Moleski is hereby assessing civil penalties for failure to correct two citations. These civil penalties accrue in the amount of $100 per day per citation between 03/05/2025 and today's date, 03/10/2025, totaling $600 each.

An exit interview was held with Longmore. Appeal rights and a copy of this report were left with Longmore.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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