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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850090
Report Date: 12/23/2024
Date Signed: 12/23/2024 11:47:31 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240731163451
FACILITY NAME:SUNSHINE RESIDENTIAL HOME BALBOAFACILITY NUMBER:
195850090
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:7431 JELLICO AVENUETELEPHONE:
(818) 274-1809
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY:4CENSUS: 4DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Toluwalope Jose via phoneTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee does not ensure that staff are adequately trained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility regarding the above noted allegation. The purpose of the visit is to deliver findings for the above allegation.

The initial visit was conducted on 08/05/2024. On today's visit at 10:45 A.M., LPA Conway was greeted by staff Muskimah "Kenny" Adebisi who contacted Administrator via phone. Administrator, Joseph Jose and Back-up administrator, Toluwalope Jose were unable to be present during today's visit. Between 11:04 A.M. and 11:30 A.M., the LPA had a phone conversation with the back-up administrator. During this conversation, the LPA read today's report, and the back-up administrator authorized Muskimah "Kenny" Adebisi to sign the report on their behalf. Reason for the visit was explained. Entrance interview conducted.

On todays visit LPA Conway conducted a physical plant tour at 10:55 A.M. to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20240731163451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
VISIT DATE: 12/23/2024
NARRATIVE
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Continued from LIC 9099

It was alleged that Licensee did not ensure that staff are adequately trained as In-Service Training documentation did not provide general (required) information.

During the course of the investigation, on 08/05/2024, LPA conducted a tour of the physical plant with Administrator and requested relevant documents. Additionally, between 12:30 P.M. and 1:30 P.M., LPA interviewed administrator and staff members. Interviews with staff revealed that there is online training in place for employees and occasionally the administrator conducts in-service training sessions. Interview with the administrator confirmed that a third-party service is utilized to provide in-house training. To investigate this complaint, LPA conducted an audit on the facilities in-service training and a facility’s file review. A review of in-house training documentation revealed that some training was conducted after the annual visit from the North Los Angeles County Regional Center conducted on 07/30/2024. However, training records lacked key information, including a description of the training provided and resources or materials related to specific subjects. Audit identified significant gaps in the facility’s staff training practices. Furthermore, the audit revealed that the facility administrator was unable to provide documentation of the required training hours for all staff members. Based on information obtained, audit preformed and a credible witness there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Staff does not have sufficient training is deemed substantiated at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240731163451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2025
Section Cited
CCR
80065(f)
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80065 Personnel Requirements
(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill... assigned and as evidenced by safe and effective job performance.This requirement is not met as evidenced by…
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Administrator agrees to obtain documentation of appropriate necessary training for staff. Documentation of the training shall be provided to CCL before POC due date.
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Based on record review, the licensee did not comply with the section cited above as staff do not have appropriate competency training for staff to meet residents’ needs.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3