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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408218
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:19:03 PM

Document Has Been Signed on 02/15/2024 03:19 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, 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: 1DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Fernando & Natalia Maniclang, Care StaffTIME COMPLETED:
03:15 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Home II, unannounced to conduct the Annual Inspection. LPA rang the doorbell and was greeted by Care Staff, Fernando Maniclang. Natalia Maniclang, Care Staff also present. Mr. Maniclang contacted Administrator, Lourdes Albao to notify of LPA visit. LPA spoke with Administrator over the phone who reported that she was en route to the facility and LPA could request records from Staff at the facility.

LPA conducted a general overall inspection with care staff, which included, but was not limited to, the following:

Physical Plant: The facility is comprised of has 3 Resident Rooms, 1 Staff Room, 2 Bathrooms, Kitchen, Dining Room, Living Rooms, Attached Garage, and Backyard. The facility maintains a partnership with the Inland Regional Center at a Level III (3). The facility is approved for six, (6) non-ambulatory, 1 bedridden resident and 1 wheelchair bound resident. LPA was informed the current census at the time of visit was 1. Remaining resident were at their prospective day programs. The facility is operating in the capacity approved by Community Care Licensing (CCL). Pathways inside and outside of the facility were free of obstructions. The facility was maintained at a comfortable temperature. Resident Rooms were observed orderly and contained all required furnishings such as beds with proper linens, night stands, adequate storage space and lighting. The facility is equipped with functional smoke/fire detectors and carbon monoxide alarms. Administrator reports fire/disaster drills are ran on a monthly basis. Fire extinguisher was observed near the kitchen; last inspected March 2023. Backyard provides sufficient space, shady and adequate seating. Pathways free of clutter and obstruction. Garage, the facility maintains their laundry room inside the garage. Also observed were extra Personal Protective Equipment, cleaning supplies, refrigerators for extra food storage and emergency food and water supply. The garage was observed to be secure inaccessible to residents in care. A hallway closet provided a secure space for the resident's medications and records. Staff files are also maintained securely in the staff area. First Aid kits were also observed in this area.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNSHINE HOME II
FACILITY NUMBER: 366408218
VISIT DATE: 02/15/2024
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Food Service: LPA observed the facility kitchen pantry and refrigerator. The facility's amount of non-perishable and perishable food supply was sufficient for the amount of residents in care. Posted food menu listed a variety of options for residents to select from. Non-perishable and perishable food supply is sufficient for number of clients residing in the facility. Facility has a variety of food available for clients. Adequate amounts Dishes, cups, and utensils were also observed in proper storage. Emergency food and water were also observed stored in the attached garage. Sharp objects and cleaning supplies are kept secure and inaccessible to residents in care. Water temperature was tested and found within required limits.

Signs: LPA observed the following posters: Infection Control, Long Term Care Ombudsman, Facility License, SEE/SAY Something, Resident Rights, Food Menu, Facility Sketch/Evacuation Plan.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. As two of the care staff reside within the facility.

Record Reviews: Staff Files files included current Health Screening, Personnel Records, Criminal Records Clearences, Background Statements and Fingerprinting, Annual Training.

LPA reviewed three resident files for Admission Agreements, Updated Physician Reports, and Needs and Services Plans.

Based on observations, no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Licensee.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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