197607506-7-30-2024-31-AS-LNCA-D7P4FY-20240730190441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607506
Report Date: 07/30/2024
Date Signed: 07/30/2024 07:05:47 PM

Document Has Been Signed on 07/30/2024 07:05 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNSHINE'S PLACE II		FACILITY NUMBER:	197607506
ADMINISTRATOR:	ROSARIO SORIANO		FACILITY TYPE:	740
ADDRESS:	7328 QUARTZ AVE.		TELEPHONE:	(818) 739-0492
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 4	DATE:	07/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Rosario Soriano- Administrator		TIME COMPLETED:	02:47 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 Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff, Aguida Roche and explained the reason for the visit. Approximately, around 10:18 AM administrator Rosario Soriano arrived and was explained for the reason of the visit. At 10:34 AM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 1/10/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory; cleared for 2 hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Office space is in the kitchen area beside the pantry. Properly labeled medications were locked in the dining area cabinets in the kitchen. Bedrooms: There were six (6) bedrooms designated for residents' and staff use. Five (5) of the that are in use by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1, #2, #3, and #4 are properly furnished and occupied by only one (1) resident. Room #5 is shared room, but has only one (1) occupant. There is one (1) staff bedroom in the facility and is located beside the garage, staff bedrooms are locked with no medication in sight. Continue to LIC 809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE'S PLACE II	FACILITY NUMBER: 197607506
	VISIT DATE: 07/30/2024

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Bathrooms: There are three (3) bathrooms designated for residents' and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105.1 degrees Fahrenheit for bathroom #1 located in the hallway beside bedroom #3. Bathroom #2 measured 106.1 degrees Fahrenheit inside bedroom #1. Bathroom #3 is located in the hallway beside bedroom #4, hot water measured at 106 degrees Fahrenheit. Cleaning supplies are being stored in a locked cabinet in the laundry room in the garage. Towels and washcloths are not shared. There was enough clean linen available in the cabinets at the end of the hallway..

Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6).

Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the laundry room in the detached garage. The facility does not have a swimming pool or body of water. The garage is detached and is used for storage for incontinence for residents and staff refrigerator. Fire place in the living room is closed, block-off and non-operational.

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

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

Medications: Medication and Medication Records (MMR) were review for proper documentation. First aid kid is also current and complete.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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