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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671019
Report Date: 09/16/2023
Date Signed: 09/16/2023 04:45:01 PM

Document Has Been Signed on 09/16/2023 04:45 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE HOME FOR EXCEPTIONAL RESIDENTSFACILITY NUMBER:
191671019
ADMINISTRATOR:JEFFERSON, REBEKAHFACILITY TYPE:
735
ADDRESS:14917 S WILLIAMS AVETELEPHONE:
(310) 637-5610
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 6CENSUS: 4DATE:
09/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Rebekah JeffersonTIME COMPLETED:
05:00 PM
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On 09/16/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Annual inspection visit using the New Care Inspection Tool. LPA met with Rebekah Jefferson, Administrator, and the purpose of today’s visit was explained. There are currently (4) Regional Center consumers in placement. All (4) clients are ambulatory.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 3 bathrooms, family room/office, living room, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry room. LPA Richard and Administrator Jefferson toured the entire facility inside and out.

Documents are posted as mandated by the DPH and CCLD. Bedroom 1 vacant & 2 and 4 occupied by clients and contain the mandated furniture. Bedroom 3 is a staff bedroom. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. LPA conducted a records review of (4) Resident records, (3) staff records. staff along with medications. The hot water temperature is at 109.8F degrees. A comfortable temperature is maintained in the facility. The supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate. Hazardous toxins and/or items are inaccessible to clients. Fire extinguisher is fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE HOME FOR EXCEPTIONAL RESIDENTS
FACILITY NUMBER: 191671019
VISIT DATE: 09/16/2023
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During the visit, LPA did not observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, sanitizer/soap in the staff bathroom and additional sanitation supplies in a locked cabinet . LPA observed an isolation room and required postings throughout the facility. The facility has an approved Mitigation plan. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

A technical Violation was issue.

An exit interview conducted and plan of correction was developed with Administrator Jefferson a copy of the report and appeal rights were provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023
LIC809 (FAS) - (06/04)
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