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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880681
Report Date: 11/04/2022
Date Signed: 11/04/2022 01:22:21 PM

Document Has Been Signed on 11/04/2022 01:22 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:SUNSHINE BOARD & CAREFACILITY NUMBER:
361880681
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
740
ADDRESS:720 N LINDEN AVETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 12CENSUS: 12DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Estrella Heller- CaregiverTIME COMPLETED:
01:32 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic.

LPA met with Administrator Najeh Hamed and was granted entry to the facility. At the time of the visit there were four (4) staff, and twelve (12) residents present.

LPA toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Najeh Hamed. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating residents and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The entrance of the facility has a check in process for staff and visitors that includes a temperature and symptom check. The facility has hand sanitizer available and the bathrooms were stocked with hand soap and paper towels. Postings were seen throughout the facility for proper cough etiquette, proper hand washing procedure, and social distancing guidelines. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the hall closet. The facility has a supply of PPE items such as gloves, gowns, disinfectant, surgical masks, and hand sanitizer. The facility was informed they need to obtain a supply of N95 masks. All staff and residents are practicing COVID-19 precautions, which minimize the risk of them contracting COVID-19.

During today’s visit, LPA found that Staff(S1) has been working at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency and a $500-dollar civil penalty.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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Document Has Been Signed on 11/04/2022 01:22 PM - It Cannot Be Edited


Created By: Ryan Gardner On 11/04/2022 at 12:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(1)
87355. Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2022
Plan of Correction
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The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 11/5/22.
Type A
Section Cited
CCR
87465(h)(5)
87465.Incidental Medical and Dental Care. (h)The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by storing resident's medications in a plastic weekly containers that are not the received container from the pharmacy which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2022
Plan of Correction
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The licensee has agreed to read regulation 87465 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to train all staff on medication safety and storage. The licensee has agreed to send LPA documentation that a medication safety class has been scheduled. The licensee has agreed to send LPA documentation that each staff member has attended the medication training, this includes staff dates and signatures as evidence of attendance. POC is due 11/5/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
LICENSING EVALUATOR NAME:Ryan Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 11/04/2022
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During todays visit, LPA found that the residents centrally stored prescription medications were removed from the original received containers and were being stored in plastic weekly containers which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency. LPA took pictures of the medication stored in the plastic weekly containers.

Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809), LIC809D, LIC811, LIC421BG, LIC9102, and appeal rights were discussed and provided to Najeh Hamed.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
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