<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920136
Report Date: 03/29/2024
Date Signed: 03/29/2024 02:49:00 PM

Document Has Been Signed on 03/29/2024 02:49 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 VILLAGE LLC, THEFACILITY NUMBER:
345920136
ADMINISTRATOR:CARMEN BUJORFACILITY TYPE:
740
ADDRESS:7948 SUNRISE BLVDTELEPHONE:
(916) 412-6190
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
03/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator- Carmen BujorTIME COMPLETED:
02:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/29/2024, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived announced at the facility to conduct a pre-licensing inspection. LPA met with Administrator, Carmen Bujor, and explained the purpose of the visit.

During today's inspection, LPA and Administrator conducted a tour of the interior and exterior of the facility to ensure there is no immediate health, safety and personal rights violation. Areas toured include but not limited to three (3) shared residents bedrooms, caregiver bedroom, two (2) bathrooms, laundry room, kitchen, garage, backyard, and common areas. LPA observed resident bedrooms to have required furniture. LPA observed the facility to have a proper storage for medications, toxins and sharps which is locked and inaccessible to residents. Hot water temperature was measured at 116 degrees Fahrenheit in kitchen sink, which is within the required range of 105 to 120 degrees. Each bedroom has their own AC unit and residents will be able to control the temperature. First aid kit was completed. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed fire extinguisher last serviced on 04/18/23. LPA observed the exterior of the facility to be free of obstruction. The facility has a safe dispersal area in case of an emergency.

LPA observed the facility to have the required posters of Community Care Licensing Division and Long Term Care Ombudsman. LPA provided Administrator a copy of LIC 311F.

Pre-licensing passed and LPA waived Component III. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1