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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604696
Report Date: 02/11/2025
Date Signed: 02/11/2025 06:59:09 PM

Document Has Been Signed on 02/11/2025 06:59 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SIERRA SUNSHINE CAREFACILITY NUMBER:
374604696
ADMINISTRATOR/
DIRECTOR:		CHAPARI, CINDYFACILITY TYPE:
740
ADDRESS:1355 HACIENDA DR.TELEPHONE:
(657) 259-8146
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 6CENSUS: 4DATE:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:00 PM
MET WITH:Shawn Chapari, Licensee, and Cindy Chapari, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:05 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 (LPA) Carmen Lopez conducted an unannounced complaint visit and in conjunction conducted this case management for issues identified while conducting today’s visit. LPA Lopez identified herself and was granted entry by caregiver Pouya “Paul” Ghorbanpour and explained the purpose of the visit. LPA met with licensee Shawn Chapari and administrator Cindy Chapari who later arrived and joined the visit.

During LPA’s tour of the facility, LPA spoke with residents. Resident #1 (R1) had mentioned during their interview, that some outlets throughout the facility had shorts. During the interview, LPA was granted permission by R1 to plug in a charger. LPA observed that the outlet did have a short, as the outlet sparked when LPA plugged in the charger.

During further interviews it was discovered that resident #2 (R2) had medication in their drawer provided by their family. LPA observed that R2 did in fact have 2 medications in their drawer to assist with their bowel. Both medications were new and were unopened.

Deficiencies were observed and cited during today's visit and can be reviewed on the attached LIC809-D page of this report.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with licensee Shawn Chapari and administrator Cindy Chapari. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to licensee Chapari at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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
Document Has Been Signed on 02/11/2025 06:59 PM - It Cannot Be Edited


Created By: Carmen Lopez On 02/11/2025 at 05:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SIERRA SUNSHINE CARE
FACILITY NUMBER: 374604696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2025
Section Cited
CCR
87465(h)(2)

1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee and administrator removed the medications from the residents room during the visit. POC is deemed cleared.
8
9
10
11
12
13
14
Based on LPA observations and interviews, facility did not centrally store the residents medication in a safe and locked location. This posed a potential health risk to 1 of 4 residents in care.
8
9
10
11
12
13
14
Type B
03/12/2025
Section Cited
CCR80075(e)(2)(D)

1
2
3
4
5
6
7
80075 Health Related Services (e)(2) (D) All electrical equipment is checked for defects that may cause sparks… This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee agreed to ensure that the electrical outlets are checked and the defects are corrected and inform LPA by POC due date, 03/12/2025.
8
9
10
11
12
13
14
Based on LPA observations and interviews, facility did not ensure that the electrical outlets had no defects. This posed a potential safety risk to 1 of 4 residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Robyn Clark
LICENSING EVALUATOR NAME:Carmen Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2