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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601808
Report Date: 07/05/2022
Date Signed: 07/05/2022 12:15:41 PM

Document Has Been Signed on 07/05/2022 12:15 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE HEIGHTS IIFACILITY NUMBER:
198601808
ADMINISTRATOR:DR. ELKE SENEGALFACILITY TYPE:
740
ADDRESS:4907 MAYMONT DR.TELEPHONE:
(310) 902-9919
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 6CENSUS: 6DATE:
07/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Dr. Elke Senegal TIME COMPLETED:
12:30 PM
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On 07/05/2022 at 10:38 am, Licensing Program Analyst (LPA) Agard conducted an unannounced required annual visit with a primary focus on Infectious Control measures using the new CARE inspection tool. Upon arrival at the facility, LPA Agard conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report.

The facility is licensed for six (6) residents of which one (1) may be bedridden. Currently, there are six (6) residents present during today’s visit.

LPA met with Administrator, Dr. Elke Senegal and both toured the inside and outside grounds of the facility. LPA was not properly screened for Covid-19 symptoms and temperature was not checked.

During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station near the facility entrance with visitor’s log. The designated visitation area is in the front room or resident’s bedroom of the facility. The staff were observed with a face covering. LPA observed a few required covid postings throughout the facility.

All rooms (6) were inspected. All rooms were individual. Bed linen were sufficient in amount, mattresses were observed in good condition, adequate lighting was provided, storage for resident’s personal belongings was observed.

Furniture in the living room observed to be in good condition. There are no weapons on the premises. Residents bathrooms (4) were checked, toilets and water faucets worked properly. The water temperature measured at 108 F. A comfortable temperature was maintained in the facility.

LPA toured the kitchen area and observed a 2-day supply of perishable and a 7-day of non-perishable food. Cleaning supplies were observed locked. Centrally stored medications were observed stored in their originally received containers and observed locked and inaccessible to residents in care. One fire extinguisher was

Cont. on 809C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2022
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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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 HEIGHTS II
FACILITY NUMBER: 198601808
VISIT DATE: 07/05/2022
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observed fully charged in the laundry room.

Outside grounds were toured, no bodies of water were observed. Walkways around the home were generally clear of hazards. Common areas were observed clean; All doorways were free of obstruction.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
LIC809 (FAS) - (06/04)
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