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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850090
Report Date: 06/19/2025
Date Signed: 06/19/2025 06:59:55 PM

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
06/13/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250613123143
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:
06/19/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Toluwalope JoseTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not meeting the Emergency Intervention Training requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. Staff greeted the LPA and called the Administrator to inform them of the visit. The Administrator Toluwalope Jose arrived therafter, and the LPA explained the reason for the visit.

LPA Urena, along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations.

LPA Urena interviewed the Administrator at approximately and requested records pertinent to the investigation.

Continues on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250613123143
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: 06/19/2025
NARRATIVE
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On the allegation that staff are not meeting the emergency intervention training requirements, it is the concern of the Reporting Party (RP) that facility staff do not have valid Crisis Prevention Intervention (CPI) certification cards, based on the record review and validation of the CPI cards available at the facility, which were audited on June 2, 2025. The LPA interviewed the Administrator about the validity of the cards, and the Administrator stated that according to their records, the company providing the training was certified, however they were unaware that the trainer was not certified.

Based on the information obtained through a credible source, and information obtained through the interview, three staff did not received training from a certified trainer; consequently, it rendered their CPI cards invalid. Therefore, the allegation that staff were not certifiably trained accordingly, is deemed Substantiated at this time.



Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D).

Citations were issued. Interview exit was conducted. A copy of the report and Appeal Rights were issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250613123143
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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2025
Section Cited
CCR
85165(a)(c)
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85165(a)(c)The licensee shall ensure staff who use, participate in … Emergency Intervention Plan and which are not prohibited, ( c) in Section 85102”, (c) “The training shall be provided by an individual holding a valid instructor
certificate from a program for preventing and safely managing dangerous behavior. The licensee shall maintain a copy of the trainer's certificate and make it available for review, inspection, audit, and copy, upon request, by the Department. This requirement is not met as evidenced by:
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Sunshine Balboa Administrator will ensure that all staff providing direct care to residents receive CPI training by a certified instructor by July 9, 2025. Administrator will submit proof to LPA via email.
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Based on observatio and information obtained through the annual audit and Administrator interview, three (3) facility staff did not have valid Crisis Prevention Cards (CPI) certification cards.
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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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
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