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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002390
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:01:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUNSHINE ASSISTED LIVING-THE HOUSEFACILITY NUMBER:
045002390
ADMINISTRATOR:KREPELKA, LARRYFACILITY TYPE:
740
ADDRESS:1463 E. DOTTIE LANETELEPHONE:
(530) 872-0375
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:15CENSUS: 0DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Larry Krepelka - licenseeTIME COMPLETED:
12:30 PM
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9/29/2021 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with licensee Larry Krepelka and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask, gloves. Additionally, LPA Knight was screened by licensee Larry Krepelka.

The facility was effected by the 2018 Camp Fire and as a result it has not been re-opened. There are no residents in care at this time. Licensee will contact Licensing if and when they decide to re-open.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report will be emailed to licensee Larry Krepelka.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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