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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366408218
Report Date: 08/19/2025
Date Signed: 08/19/2025 12:49:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250814152049
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: 4DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rosario Nicolas, Licensee, and Lourdes Albao, AdministratorTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Facility has an infestation of Ants
Facility has an infestation of Roaches/ Rodent droppings.
Facility has mold in the freezer/refrigerator.
Boxes are out throughout the facility with clothing and unknown various items.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to commence a complaint investigation. LPA was greeted and granted entrance by Caregiver, Tessie Martinez. LPA identified herself and discussed the purpose of the visit. LPA ask Caregiver Tessie Martinez, to inform the Administrator Lourdes Albao or the Licensee Rosario Nicolas of my arrival. LPA spoke to Licensee Rosario and she informed me that Caregiver Tessie would assist me and she would call the Administrator Lourdes. During today’s visit, LPA toured the facility, interviewed staff, reviewed and collected documents.

The first allegation is: Facility has an infestation of ants. LPA Farlow interviewed S1, S2, and S3 they stated we did have ants but we have a contract with Orkin and they provided service on 8/8/2025. Based on LPA Farlow observation it appears the ant concern is resolved and under control. LPA Farlow did not find evidence to corroborate the allegation.
***Continued in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20250814152049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HOME II
FACILITY NUMBER: 366408218
VISIT DATE: 08/19/2025
NARRATIVE
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The second allegation is: Facility has an infestation of Roaches/Rodent droppings. LPA interviewed S1, S2, and S3, and the staff stated they have never seen any roaches in the facility, and the home has never been infested with roaches. Interview with S1, S2, and S3 stated they did see something black on the floor and we cleaned it up, but we have never seen any rodents. S2 and S3 stated we have a contract with Orkin for treatment every 2 months for one year. LPA Farlow did not find evidence to corroborate the allegation.

The third allegation is: Facility has mold in the freezer/refrigerator. Based on LPA Farlow observation the freezer/refrigerator was free of mold and all food was labeled. Interview with S2 stated it was blood and not mold. LPA Farlow did not find evidence to corroborate the allegation.

The fourth allegation is: Boxes are out throughout the facility with clothing and unknown various items. LPA Farlow conducted a tour of the facility and did not observed boxes left out blocking any pathway or obstructing any walk ways. S2 and S3, stated they have not had any boxes obstructing any pathway making it unsafe for residents in care.

Based on LPA Farlow’s interviews, and observation, the allegations are Unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted where this report, LIC9099, and LIC9099C, was discussed and provided to Licensee, Rosario Nicolas.

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

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2