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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002828
Report Date: 10/24/2024
Date Signed: 10/24/2024 04:49:47 PM

Document Has Been Signed on 10/24/2024 04:49 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:SUNRISE SENIOR CAREFACILITY NUMBER:
345002828
ADMINISTRATOR/
DIRECTOR:
HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:6729 SUGAR MAPLE WAYTELEPHONE:
(916) 745-4167
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Steve Heydon, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA initially met with Steve Heydon, Administrator Designee, and explained the reason for the inspection. Administrator, Anita Heydon, arrived at 12:15 pm. Also present was staff, Ram Pratap. LPA observed (2) residents watching television in the common area, (3) residents resting in their rooms, and (1) resident returned to the facility during the inspection. The facility is licensed for (6) residents and has a hospice waiver for (3). There are currently no residents under hospice care.

LPA and Administrator Designee toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. There is 2+day perishable and 7+day non-perishable supply of food with additional freezer storage in the garage. Sharps are locked in the kitchen. The bathrooms have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. Locked medications are secured near the kitchen and toxins are locked in the garage and bathroom.

The inside temperature measured 70*F. Fire extinguisher was last serviced 5/21/24, and the smoke/monoxide alarms are working. Hot water temperature measured 109*F in the kitchen. There is a complete First Aid kit. There are sufficient linens/towels/paper products/PPE. There is an outside patio table with chairs and an umbrella, and one unlocked exit. There are no pools.

The Infection Control and Emergency Disaster Plans were complete and reviewed within the last year. (3) resident files were reviewed/found to be organized and contain current paperwork. Medications were reviewed for (2) residents- orders matched medications being administered. Documentation was current.

cont on 809C.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNRISE SENIOR CARE
FACILITY NUMBER: 345002828
VISIT DATE: 10/24/2024
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809C-1.. (4) staff files were reviewed. All staff is cleared and associated. Files were organized and complete. Initial and/or ongoing training documentation was filed. Staff has current First Aid/CPR certifications and will ensure all required ongoing training hours are completed by 11/30/24. An approved on-line vendor is used for staff training.

Administrator certification #7019616740- exp 7/4/25 posted at the front entrance.

LPA requested an updated copy of LIC500, LIC308 and of the current liability insurance by 10/31/24.
Obtained updated email address.

Administrator to submit documentation of required staff training hours to be completed within the last 12 months, by 11/30/24.

There are no deficiencies issued, but there is a Technical Violation being issued.

Exit interview with Administrator. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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