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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850090
Report Date: 09/23/2022
Date Signed: 10/31/2022 09:54:47 AM

Document Has Been Signed on 10/31/2022 09:54 AM - It Cannot Be Edited

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. #250
WOODLAND HILLS, CA 91364
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:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Oyinloye Austine JoseTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Brian Balisi  arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA was screened by Administrator and LPA explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures.

At approximately 1pm,  LPA along with Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Fire extinguishers were observed fully charged and last serviced in July 2022. There was (1) client in care during the visit. The other clients were at their day programs.

Kitchen appliances were observed to be clean and in operable condition. LPA observed a sufficient supply of perishable and non-perishable food properly stored. Sharp objects were observed in a locked cabinet underneath the sink.

LPA observed resident bedrooms furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. Middle hallway closet was observed to store clean linen and hallway closet to the right of entry was observed to store emergency food supplies, PPE, toiletries and cleaning supplies.

Restrooms were observed to be relatively clean, sanitary and in operating condition. Hot water measured between 105 - 120 degrees Fahrenheit.

Infection control signs were observed posted throughout facility to promote hand washing, cough/sneeze etiquette, and physical distancing
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
VISIT DATE: 09/23/2022
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Continued from  LIC-809 

LPA observed the back patio, which has a covered outdoor area with a appropriate seating for outdoor use. There is a self-latching gate on the side and back of the facility designated for an emergency exits. Laundry room was observed locked and inaccessible to clients in care. Extra perishable and non-perishable food was observed properly stored.

INFECTION CONTROL: The LPA spoke with Administrator  regarding the facility’s infection control practices. pon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate bedroom #2 as the isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing will be conducted twice a week along with PCR testing. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

No deficiencies were observed at this time. Exit interview conducted. Report issued and a copy of the report was provided via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
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