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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408218
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:37:55 PM

Document Has Been Signed on 09/29/2022 01:37 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 HOME IIFACILITY NUMBER:
366408218
ADMINISTRATOR:ALBAO, LOURDESFACILITY TYPE:
740
ADDRESS:2158 SYCAMORE AVENUETELEPHONE:
(909) 874-8114
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 6CENSUS: 2DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ceasar Allejo, care providerTIME COMPLETED:
01:39 PM
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Licensing Program Analyst (LPA) Anna Bueno 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 care provider, Ceasar Allejo, who confirmed that there are currently no cases/exposures of COVID-19 within the facility. Licensee Rosario Nicolas was phoned and arrived shortly during today's visit.

During the inspection, LPA and care staff conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. LPA Bueno observed that the facility was also equipped with sufficient hand hygiene and cleaning/disinfecting supplies. 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 facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the client presents any COVID-19 symptoms.

LPA Bueno observed no health and safety concerns at the time of visit. A technical advisory is issued as LPA observed multiple unopened boxes of clothing items in the living room. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations.

An exit interview was conducted where this report was discussed with and a copy was provided to Licensee Nicolas at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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