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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880681
Report Date: 07/31/2023
Date Signed: 07/31/2023 01:29:56 PM

Document Has Been Signed on 07/31/2023 01:29 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: DATE:
07/31/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Manal Terab - care staffTIME COMPLETED:
01:32 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced proof of correction (POC) visit to a deficiency issued on 06/12/2023. LPA informed care staff Manal Terab of the purpose of today's visit and Terab phone co-administrator Yusef Nofal of LPA's presence. LPA informed Nofal of today's visit and Licensee Najeh Hamed arrived during the visit.

The following deficiency was not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted:
    • Deficiency cited under Title 22 Regulation 87507(g)(5)(C)(2) and POC was for Licensee to refund all monthly payments made by Resident 1 (R1) authorized representative and proof of correction shall be provided to the Department by the POC date of 7/14/2023. Proof of refund issued or arrangements was not received by LPA during today's visit. Licensee stated that they intend to appeal the deficiency and civil penalty.

Civil penalties assessed today at the rate of $100 per day per citation per violation per day. Today's civil penalty assessment of $1700.00 is for the period of 07/15/23 through 07/31/23. Civil Penalties assessed today total $1700.

Exit interview conducted with and a copy of this report, LIC421, and appeal rights were provided to Licensee Hamed.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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