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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408218
Report Date: 12/05/2022
Date Signed: 12/05/2022 12:46:34 PM

Document Has Been Signed on 12/05/2022 12:46 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:
12/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Licensee Rosario NicolasTIME COMPLETED:
12:48 PM
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Licensing Program Analysts (LPAs) Anna Bueno and Amber Coleman conducted a case management visit to the facility to confirm the removal of multiple unopened boxes of clothing items in the living and dining room that LPA Bueno observed on 09/29/2022 visit.

During today's visit, LPAs observed the living and dining rooms to be clear from clutter. Licensee Rosario Nicolas stated that the unopened clothing boxes in the outdoor back patio will be moved to the two sheds within a few weeks.

No deficiencies were cited during today's visit. An exit interview was conducted where this report was discussed and a copy was provided to Ms. Nicolas at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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