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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045003002
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:42:52 PM


Document Has Been Signed on 06/14/2023 02:42 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SUNSHINE ASSISTED LIVING- THE HOUSEFACILITY NUMBER:
045003002
ADMINISTRATOR:BAKER, JENNAHFACILITY TYPE:
740
ADDRESS:1463 E. DOTTIE LANETELEPHONE:
(530) 872-0375
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:15CENSUS: 0DATE:
06/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Jennah BakerTIME COMPLETED:
12:45 PM
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06/14/2023 11:00 AM Licensing Program Analyst (LPA) Sarah Benson and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility unannounced to conduct a Pre-Licensing Required inspection. LPA and LPM met with Jennah Baker Administrator and explained the purpose of the visit.


LPA Benson and LPM Crocker with the administrator to tour the facility. Areas toured include but are not limited to fifteen (15) resident rooms, common areas, 16 (16) bathrooms, kitchen, storage areas and yards. No residents are on premises.

Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Medication is locked in a locked closet.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. All required postings are displayed within facility.

No pools/bodies of water are on premises. No firearms are on premises.

No deficiencies are being cited as a result of today’s inspection.



Exit interview conducted and copy of report was provided to administrator Jennah Baker Administrator.

THIS FACILITY IS READY TO BE LICENSED.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah BensonTELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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