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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
191222209
Report Date:
11/05/2020
Date Signed:
11/05/2020 03:09:05 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
SUNSHINE RESIDENTIAL CARE FOR THE ELDERLY
FACILITY NUMBER:
191222209
ADMINISTRATOR:
CELEDIO, REGINA
FACILITY TYPE:
740
ADDRESS:
19926 LORNE STREET
TELEPHONE:
(818) 882-8091
CITY:
CANOGA PARK
STATE:
CA
ZIP CODE:
91306
CAPACITY:
3
CENSUS:
0
DATE:
11/05/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:45 AM
MET WITH:
Reguba Celedio
TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Wendell Smith conducted a virtual closure visit via Face-time with administrator/licensee Regina Celedio. Visit was conducted virtually do to the Covid-19 pandemic.
LPA was given a physical plant tour. LPA was able to verify that no one needing care and supervision was residing in the facility. LPA sent administrator an email with the link to the closure survey. Administrator stated she would complete the survey by the end of today. Exit interview conducted. Copy of report emailed for signature.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/05/2020
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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