<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671019
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:37:40 PM

Document Has Been Signed on 04/03/2024 02:37 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SUNSHINE HOME FOR EXCEPTIONAL RESIDENTSFACILITY NUMBER:
191671019
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:
JEFFERSON, REBEKAHFACILITY TYPE:
735
ADDRESS:14917 S WILLIAMS AVETELEPHONE:
(310) 637-5610
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 6CENSUS: 4DATE:
04/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
01:13 PM
MET WITH:Administrator Rebekah JeffersonTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 04/03/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Rebekah Jefferson as the purpose of the visit was explained. The facility is licensed to serve (6) ambulatory only developmentally disabled clients ages 18-59. Facility is approved for (2) elderly clients, (1) over age 64. Clients are linked to the South Central Los Angeles Regional center. Current facility census is (4), facility fees are current.

The facility is a single-story structure located in a residential neighborhood and consists of the following: (3) client bedrooms, (1) staff bedroom, 3 bathrooms, family room, office area, living room, kitchen, dining room, indoor and outdoor activity area, and laundry area. Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to clients, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 2 staff records, 2 client records, 2 P&I ledgers and 2 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted in November 2023, fire extinguisher fully charged, carbon monoxide and smoke detectors are interconnected and operational. No deficiencies cited during today's visit.

Exit interview conducted with Administrator Rebekah Jefferson, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1