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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608187
Report Date: 08/14/2023
Date Signed: 08/14/2023 12:12:02 PM


Document Has Been Signed on 08/14/2023 12:12 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:SUNSHINE HOME CARE II, LLC.FACILITY NUMBER:
197608187
ADMINISTRATOR:ERIKA TOTHFACILITY TYPE:
740
ADDRESS:1871 247TH STREETTELEPHONE:
(310) 326-6134
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:6CENSUS: 5DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Administrator Erika TothTIME COMPLETED:
12:32 PM
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On 08/14/2023, Licensing Program Analyst (LPA)Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Erika Toth and Designated caregiver Rodante Cruz as the purpose of today’s visit was explained. The facility is licensed to operate for six (6) elderly residents ages 60 and above, the facility is approved for four (4) non-ambulatory residents, two (2) bedridden and two (2) hospice.

The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident's rooms, three (3) bathrooms one (1) of which is private, a living room area, dining area and kitchen. There is a detached garage located in the back of the facility used for storage only. The washer and dryer are located as you enter the facility, and a shaded patio.

LPA and house manager toured the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, sharps and toxins were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food. There was one (1) fire extinguisher fully charged located in the kitchen area. Landline, first aid kit and manual observed, smoke detectors and carbon monoxide were operable. Last fire drill conducted on 8/8/23. A review two (2) resident files, two (2) staff files and two (2) Medication Administration Records (MAR).
Exits/ Walkways around the facility were free of debris and hazards.
During today’s visit no discrepancies were cited. Exit interview conducted with Rodante Cruz, and a copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
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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