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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201075
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:07:34 PM

Document Has Been Signed on 11/13/2023 03:07 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:A RAY OF SUNSHINEFACILITY NUMBER:
019201075
ADMINISTRATOR:LEE-GONZALES, MESALINA G.FACILITY TYPE:
735
ADDRESS:8111 ALDEA STREETTELEPHONE:
(510) 676-6427
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 6CENSUS: 4DATE:
11/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:LEE-GONZALES, MESALINA G., AdministratorTIME COMPLETED:
03:15 PM
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LPA Kelly Nguyen attempted to conduct an unannounced 1 year annual requirment visit. LPA arrived at the home to find no one present. LPA contact Administrator (AD) LEE-GONZALES, MESALINA G. and explained the purpose of the visit. AD stated that there's no one a the facility because all staff have to assist clients to MITC East Bay Day Program, and AD have to meet with the RECB behavioral case manager, in house CM, and Client mother.

LPA will be attempting another visit.

On 11/13/2023 at 12 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to a conduct 1-Year Annual Required inspection. LPA met with Lee-Gonzales, Mesalina Administrator and explained the purpose of the visit.

LPA toured facility with Mesalina including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 112 degrees Fahrenheit. Clients’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to Clients.


Report continue on LIC 809C...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: A RAY OF SUNSHINE
FACILITY NUMBER: 019201075
VISIT DATE: 11/13/2023
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Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/15/22. Emergency Disaster Plan was last posted on 5/15/2021. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 11/03/2023 and earthquake drill was conducted on 11/1/23.

LPA reviewed 4 residents records. LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC809 (FAS) - (06/04)
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