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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004408
Report Date: 04/21/2022
Date Signed: 04/21/2022 01:19:33 PM

Document Has Been Signed on 04/21/2022 01:19 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SUNNY BEACH VILLAFACILITY NUMBER:
347004408
ADMINISTRATOR:DIMITROVA, DESSIFACILITY TYPE:
740
ADDRESS:2506 CASTLEWOOD DRTELEPHONE:
(916) 486-4265
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 6CENSUS: 2DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Dessi Dimitrova - AdministratorTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual Inspection Visit. LPA met with the Administrator and explained purpose of the visit. Administrator Certificate #6016241740 expires 05/11/2023.

LPA toured the facility and inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA observed the Fire Extinguisher expires 02/09/2023 and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present and in working order.

LPA observed centrally stored medications, knives and toxins locked and not accessible to residents. LPA reviewed 2 resident and 3 staff files, including criminal record clearances. All staff today are Fingerprint cleared and associated to the facility. First aid/CPR certificates are current. First aid kit was checked and is complete.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited.

Exit interview held with Administrator and a report left at facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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