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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607506
Report Date: 06/16/2022
Date Signed: 06/16/2022 06:47:05 PM


Document Has Been Signed on 06/16/2022 06:47 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 IIFACILITY NUMBER:
197607506
ADMINISTRATOR:ROSARIO SORIANOFACILITY TYPE:
740
ADDRESS:7328 QUARTZ AVE.TELEPHONE:
(818) 739-0492
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 5DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:Rosario Soriano - AdministratorTIME COMPLETED:
06:45 PM
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Licensing Program Analysts (LPA) Gary Tan initially met with staff Agueda Roche for a One (1) Year Required - Infection Control visit for this facility. Staff called who called the Administrator Rosario Soriano who arrived about twenty (20) minutes later. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 4:00 PM and the following was noted:

There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.

The facility had submitted and approved Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the garage.

The facility has five (5) bedrooms and three (3) bathrooms currently occupying five (5) residents. One (1) additional bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, Hospice waiver for two (2) residents

(continued on LIC 809-C)
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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 II
FACILITY NUMBER: 197607506
VISIT DATE: 06/16/2022
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Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 72°F. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide installed at the facility. Fire extinguisher is located in the kitchen and observed to be full and last checked on 01/05/22.

The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is an structure at the backyard being used as old equipment storage and was observed to be locked during the visit. There is no body of water at the facility.

The garage is currently being used as tools, frozen food and other supplies storage. Laundry room is located in the garage. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the garage. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee.



Staff Room: Staff room was observed to be locked, located adjacent to the garage and has no access from the inside. No medications are observed in the staff room.

The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured a range of 105.2°F to 105.8°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet.

Medications: LPA observed medication cabinet in the kitchen to be locked and inaccessible to residents. There is a complete first aid kit located inside the medication cabinet.

Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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