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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209481
Report Date: 12/11/2024
Date Signed: 12/11/2024 01:56:13 PM

Document Has Been Signed on 12/11/2024 01:56 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SUNSHINE FRESNO HOME 3FACILITY NUMBER:
107209481
ADMINISTRATOR/
DIRECTOR:		BROWN, PRECIOUSFACILITY TYPE:
735
ADDRESS:22056 E DINUBA AVETELEPHONE:
(818) 274-1809
CITY:FRESNOSTATE: CAZIP CODE:
93618
CAPACITY: 6CENSUS: 4DATE:
12/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Facility Staff, Bola AnthonyTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On 12/11/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Pre-Licensing Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Administrator, Precious Brown, is not available. Facility staff contacted Assistant Administrator, Triege Surratt via telephone. Assistant Administrator was unable to attend this inspection, LPA received verbal permission to meet with facility staff, Bola Anthony. There is one client present during today's inspection.

This is a 7 bedroom, 2 bathroom home. This facility is being licensed as a change in ownership. A fire clearance was granted for 6 Ambulatory clients.

LPA reviewed facility records and observed the following: The infection control plan and emergency disaster plan were provided and reviewed. LPA reviewed client records for admission agreements, medical assessments, and care plans. LPA was unable to review staff files during today's inspection. LPA found that S1 is fingerprint cleared, but was not associated to the facility. LPA observed client roster to not be updated.

LPA conducted a facility tour with staff. LPA observed that furnishings in the common areas (living room and dining room) were in need of repair/cleaning and/or replacement. Resident bedrooms were observed to be clean and had required furnishings. LPA observed the bed frame for R3 to have a large hole in the headboard and is in need of replacement. The lamp in R2's bedroom is missing a lamp shade. Bathrooms were observed to be clean and operational. Hot water measured at 113.3 degrees F. LPA did not observe required postings including the facility visitation policy. A sample menu was observed. LPA observed the facility food supply. Medications were observed to be locked and inaccessible during today's inspection. First-Aid kit observed. Fire Extinguisher was last serviced on 12/20/2023. Smoke detector and carbon monoxide detector observed to be operational during today's inspection.

CONTINUED TO 809-C
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUNSHINE FRESNO HOME 3
FACILITY NUMBER: 107209481
VISIT DATE: 12/11/2024
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LPA requested the following deficiencies be corrected:
  • Required postings including the facility visitation policy posted in the facility
  • Bed frame replacement for R3
  • Couches and dining chairs are in need of replacement and/or cleaning and repair
  • Current and complete staff files should be maintained in the facility
  • All staff should be associated to the facility
  • Facility needs an updated client roster on file in the facility
  • Replace the lamp shade for R2

Licensee agrees to notify LPA once corrections have been made. LPA will return at a later date to verify that all items have been corrected.

LPA will notify CAB that facility is ready to be licensed once the above information has been received.

A copy of this report was provided to facility staff. Report signed on-site by facility representative.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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