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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209481
Report Date: 03/05/2025
Date Signed: 03/05/2025 03:32:13 PM

Document Has Been Signed on 03/05/2025 03:32 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
FRESNO RO, 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: 3DATE:
03/05/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Facility Staff, Michelle JohnsonTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 3/5/25, Licensing Program Analyst (LPA) J. Leffall conducted an unannounced Pre-Licensing / Component III inspection. LPA introduced self, stated purpose of visit, and was allowed entry into the facility. LPA and met with Staff (S1) Michelle Johnson. Facility staff contacted Administrator, Triege Surratt via telephone. LPA observed a visitor log / temperature check upon entry.

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 toured the facility with S1. Common areas were furnished and had adequate seating and lighting available. Bedrooms had required furnishings and are ready for occupancy. Hot water ranged from 110.4 to 115.3 degrees F. LPA observed toilet area and both toilets and showers contained grab bars. LPA observed adequate bed linens. Facility has an adequate supply of personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Cleaning supplies and chemicals were observed in a locked cabinet in laundry room. Medications are locked in a locked cabinet. First aid kit was observed and contained all required items. A fire extinguisher was observed and has a service date of 3/3/25. Smoke detectors and carbon monoxide were observed to be operational.

Outside of facility toured. Exits were open and free of obstructions. LPA and observed side gate to be self-latching.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUNSHINE FRESNO HOME 3
FACILITY NUMBER: 107209481
VISIT DATE: 03/05/2025
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LPA requested the following deficiencies be corrected:

· LIC-503 for 1 out of 3 staff

· Mattress in R3’s bedroom

Licensee agrees to send a completed LIC-503 of staff and a photo of the mattress to Licensing Program Manager (LPM) Alexandria Walton via fax or email by 3/7/25.

LPM 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: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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