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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002996
Report Date: 07/11/2025
Date Signed: 07/11/2025 10:46:13 AM

Document Has Been Signed on 07/11/2025 10:46 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNSHINE RETIREMENT HOMEFACILITY NUMBER:
306002996
ADMINISTRATOR/
DIRECTOR:		MARIETA MARQUEZFACILITY TYPE:
740
ADDRESS:17846 TACOMA CIRCLETELEPHONE:
(714) 532-6885
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY: 6CENSUS: 4DATE:
07/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Marieta MarquezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On July 11, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced annual inspection at Sunshine Retirement Home. The facility holds a license to care for six non-ambulatory residents and a hospice waiver for two individuals, although none were receiving hospice services at the time of inspection. During the visit, four residents were in care. Administrator Marieta Marquez maintains a valid certificate through October 30, 2024. A thorough tour of the physical plant and grounds revealed the home to be clean, safe, and sanitary. The facility comprises five resident bedrooms, two common restrooms, one dedicated resident restroom, a staff room, a living room, a dining room, and a kitchen. Each resident bedroom was appropriately furnished with required bed linens, adequate closet and drawer space, and functional furniture. Bathrooms were fitted with secure and operational toilets, faucets, and grab bars; showers were free of mold and mildew; and water temperatures ranged from 117.9 °F to 120.5 °F, within acceptable limits. Supplies of bath towels, toiletries, and personal hygiene products were ample, and all common areas and doorways were clear of hazards or obstructions. The kitchen was well stocked with both perishable and non-perishable foods, and all appliances operated correctly. Safety systems—including smoke and carbon monoxide detectors, fire extinguishers, and first aid kits—were tested and found fully functional and properly maintained. All toxic substances were stored securely. Outdoor areas featured ample shaded seating, and exit gates were unlocked but equipped with self-latching mechanisms. A records review encompassed three resident files and four staff files. Each resident file contained the required admission agreement, physician reports, and resident appraisal. Medications were stored securely and administered in accordance with physician orders. The facility’s emergency disaster plan and infection control plan were comprehensive and up to date. Documentation showed the most recent fire drill occurred on June 25, 2025.No violations of Title 22, Division 6, Chapter 8 of the California Code of Regulations were identified. An exit interview was held with facility administration, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Samer Haddadin
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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