<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880681
Report Date: 11/20/2024
Date Signed: 11/20/2024 12:28:33 PM

Document Has Been Signed on 11/20/2024 12:28 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SUNSHINE BOARD & CAREFACILITY NUMBER:
361880681
ADMINISTRATOR/
DIRECTOR:
HAMED, NAJEHFACILITY TYPE:
740
ADDRESS:720 N LINDEN AVETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 12CENSUS: 9DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:Yusef Nofal, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, LaVette Farlow, (LPA) arrived at the Sunshine Board and Care, Residential Care facility for the Elderly, unannounced conduct an Annual Inspection. LPA was greeted and granted entry by Caregiver, Zaid Abuawwad. LPA met with Administrator, Yusef Nofal. LPA introduced self and stated purpose of the visit. Administrator accompanied LPA on a tour of the facility and provided records for review.


The facility has 8 bedrooms in total. 6 resident rooms, 2 staff rooms, 5 bathrooms, kitchen, dining area, living room, staff lounge, (attached garage) and 2 side pathways on the exterior. LPA conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is approved to have 12 ambulatory residents, 2 of which may be non-ambulatory. At this time, operating at the capacity approved by Community Care Licensing (CCL). Pathways were observed free of clutter and obstructions. The facility was maintained in comfortable temperature of 70 degrees Fahrenheit. Water temperature measured at 116.0, 113.6, 123.9, and 116.4 degrees Fahrenheit. LPA advised Administrator of the temperature degrees and advised to place a signed for extreme heat after several attempt to adjust temperature. LPA inspected resident bedrooms; they are equipped with required furniture. LPA inspected resident bedrooms and found that each room included required furniture such as: mattresses, night stands, adequate storage and sufficient lighting, and seating. LPA inspected resident bathrooms. Bathrooms were observed to in order and included functional appliances. The facility is equipped with operational smoke detectors and carbon monoxide alarms. Administrator reports disaster drills are conducted quarterly. Posters such as; the personal and resident rights, let us know, and disaster/evacuation plans, facility license, staff and resident roasters were posted in common areas. Cleaning supplies, toxins, sharps, and other dangerous items were observed to be kept secure and inaccessible to residents. LPA observed that resident and staff files are kept secure in a designated securable cabinet in the facility's lobby area. Medications were observed secure and inaccessible to residents. Emergency and first aid kits were observed and readily available for residents in care.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE BOARD & CARE
FACILITY NUMBER: 361880681
VISIT DATE: 11/20/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Food Service: Non-perishable and perishable food supply is adequate for amount of residents in care. The facility has a posted food menu; which is published on a monthly basis for breakfast, lunch, dinner and snacks. Facility offers its resident a variety of food items such as fruits, canned goods, dry foods, chips, milk, eggs, beverage and frozen meals.. Dishes, cups, and utensils were observed to be clean and in proper storage and in adequate amounts. Emergency food and water supply were also observed.
Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members currently employed in the facility have criminal/fingerprint/background record clearance through the department.
Record Review: LPA reviewed all three (3) resident files for admission agreements, updated physician reports, and needs and services plans. Three, (3) out of three, (3) resident files were complete with all documents needed. LPA also reviewed three, (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Fire extinguisher last inspected January 19, 2024..

Based on observations, interviews and record reviews, no deficiencies will be cited per Title 22, California Code of Regulations. An exit interview was conducted. A copy of this report was read/reviewed with Administrator Yusef Nofal; signature acknowledges understanding and receipt of report.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2