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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201421
Report Date: 02/07/2023
Date Signed: 02/07/2023 12:37:36 PM


Document Has Been Signed on 02/07/2023 12:37 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:SUNSHINE CAREFACILITY NUMBER:
107201421
ADMINISTRATOR:RIGON, AURORA A.FACILITY TYPE:
735
ADDRESS:4343 NORTH AUGUSTA AVENUETELEPHONE:
(559) 221-0908
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 5DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensee Aurora RigonTIME COMPLETED:
12:45 PM
NARRATIVE
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On 2/7/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct
an Annual Inspection- Infection Control. LPA met with care staff Connie Panganiban and stated the purpose of the visit. Licensee Aurora Rigon was contacted and would be arriving to assist with inspection.

Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one
entrance/exit point. Facility staff observed without facial coverings. At 11:30 AM LPA observed the facility to have dust and dirt caked onto walls, windowsills, and fixtures. Dust was also observed around doorways in the common areas. Facility has no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Hand washing and other various Covid-19 related signs were observed in the common areas. Sharp items and chemicals were locked in the Hallway closet. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Medications observed locked in kitchen cabinet. Fire extinguisher in the kitchen was last serviced on 01/25/2023 and was fully charged. Trash cans observed without lids. Hand washing posters were observed in the bathrooms by the sink. A sample of medication was reviewed. Staff and resident records were reviewed for updated emergency contact information and health screening

Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6.

LPA is requesting the following documents be submitted to the Fresno CCL office by 2/14/2023: Current copy
of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Licensee. Report signed on-site; printed copy provided along with appeal rights. POC was discussed with Licensee.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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Document Has Been Signed on 02/07/2023 12:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: SUNSHINE CARE
FACILITY NUMBER: 107201421

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above LPA observed the facility to have dust and dirt caked onto walls, windowsills, and fixtures. Dust was also observed around doorways in the common areas., which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2023
Plan of Correction
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Licensee agrees to clean the facility and to provide proof of correction to LPA's by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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