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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880681
Report Date: 09/06/2023
Date Signed: 09/06/2023 02:44:56 PM

Document Has Been Signed on 09/06/2023 02:44 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:
09/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Ahmad AbdallatefTIME COMPLETED:
02:45 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 last visited the facility on 07/31/23. LPA met with staff who phoned co-administrator Ahmad Abdallatef. Mr. Abdallatef arrived shortly and was informed of the purpose of today's 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. The Regional Office has not received an appeal for the deficiency mentioned on this visit.

Civil penalties assessed today at the rate of $100 per day per citation per violation per day. Today's civil penalty assessment of $3700.00 is for the period of 08/01/23 through 09/06/23. Civil Penalties assessed today total $3700.

Exit interview conducted with and a copy of this report, LIC421FC, and appeal rights were provided to Mr. Abdallatef.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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