197606334-9-28-2022-31-AS-MCAA-CJPTMF-20220928145104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606334
Report Date: 09/28/2022
Date Signed: 09/28/2022 02:52:05 PM

Document Has Been Signed on 09/28/2022 02:52 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNSHINE'S PLACE		FACILITY NUMBER:	197606334
ADMINISTRATOR:	ROSARIO SORIANO		FACILITY TYPE:	740
ADDRESS:	7301 QUARTZ AVENUE		TELEPHONE:	(818) 882-0947
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 4	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Rosario Soriano		TIME 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	Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the administrator, Rosario Soriano, and explained the reason for the visit. At approximately 11:45am, with the assistance of the administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and the carbon monoxide detector is battery operated. Both function properly. The fire extinguisher is located in the kitchen. The charge date is 01/20/2022. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There are five (5) bedrooms designated for residents' use. Four rooms are being occupied by residents. One room is vacant. The four bedrooms, in use by residents were were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105.3 degrees Fahrenheit. There are no cleaning supplies stored in the bathrooms. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE'S PLACE	FACILITY NUMBER: 197606334
	VISIT DATE: 09/28/2022

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. There is a shed in the backyard that was inspected. It is being kept locked at all times. The shed is used for storage and supplies. The side gate was checked to insure it is not locked and has an easy access to exit facility grounds during an emergency. The outdoor area was free of hazards. The laundry area is located by the kitchen. Cleaning supplies and detergents were locked and inaccessible The garage area is utilized for for storage and staff quarters.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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