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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002867
Report Date: 10/16/2024
Date Signed: 10/16/2024 02:46:44 PM

Document Has Been Signed on 10/16/2024 02:46 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:SUNSHINE CARE HOMEFACILITY NUMBER:
345002867
ADMINISTRATOR/
DIRECTOR:		CRISAN, ADELAFACILITY TYPE:
740
ADDRESS:5010 OLEAN STREETTELEPHONE:
(916) 966-6042
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 3DATE:
10/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Denisa Adina Crisan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility today and met with Licensee, Denisa Adina Crisan, to follow-up regarding a report from the Local Long Term Care Ombudsman (LTCO).

During visit, LPAs interviewed resident (R1) regarding report from LTCO. LPAs observed food storage at facility and observed that the facility had a two (2) day perishable and seven (7) day nonperishable food supply on cite and food was of good quality.

LPAs also returned a check issued to the Regional Office by mistake back to the facility.

No deficiencies were cited as a result of today's visit. Exit interview was conduct. Signature on this forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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