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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608187
Report Date: 08/06/2021
Date Signed: 02/23/2022 11:28:39 AM

Document Has Been Signed on 02/23/2022 11:28 AM - 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE HOME CARE II, LLC.FACILITY NUMBER:
197608187
ADMINISTRATOR:ERIKA TOTHFACILITY TYPE:
740
ADDRESS:1871 247TH STREETTELEPHONE:
(310) 634-9293
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY: 6CENSUS: 6DATE:
08/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rodante Cruz, House ManagerTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by Rodante Cruz, House Manager and later spoke with Erika Toth via telephone, Administrator and the purpose of today’s visit was explained.

There are currently (6) residents in the facility. (0) residents are ambulatory and (6) are non-ambulatory. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes up to the facility. It consists (6) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and a detached 2 car garage.

LPA and Rodante toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-5 are occupied by residents and contain the mandated furniture. Bedroom 6 is a staff bedroom. The (3) bathrooms are clean and operational. First aid kit completes with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. 1 resident file and medications are current. 1 staff is current. Ample supply of perishable and nonperishable food, hot water temperature is 108 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 2 fire extinguishers are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap in the staff bathroom and additional sanitation supplies are locked in a hall cabinet. LPA observed staff and clients wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE HOME CARE II, LLC.
FACILITY NUMBER: 197608187
VISIT DATE: 08/06/2021
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According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Rodante Cruz, House Manager and copy of report provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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