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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201421
Report Date: 03/08/2023
Date Signed: 03/08/2023 11:38:37 AM


Document Has Been Signed on 03/08/2023 11:38 AM - 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:
03/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Licensee Aurora RigonTIME COMPLETED:
11:45 AM
NARRATIVE
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On 3/08/2023, Licensing Program Analyst (LPA) K.Kaur arrived unannounced and conducted a case management - deficiencies in conjunction with a subsequent complaint visit.

LPA observed during the facility tour the facility to have dust and dirt caked onto walls, doors, and fixtures. Dust was also observed around doorways in the common areas. Bedroom carpets had debris which had not been removed from the annual inspection which was completed on 2/7/2023. Walls had several holes in the bedrooms.

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

An exit interview was conducted with Licensee. Report signed on-site by Licensee and printed copy provided with appeal rights.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
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 03/08/2023 11:38 AM - 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: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited

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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:
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Licensee agrees to clean the facility and to provide proof of correction to LPA's by POC due date.
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Facility had dust and dirt caked onto walls, doors, and fixtures. Dust was also observed around doorways in the common areas. Bedroom carpets had debris. Walls had several holes in the bedrooms.
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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: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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