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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608474
Report Date: 07/26/2022
Date Signed: 07/26/2022 11:23:16 AM


Document Has Been Signed on 07/26/2022 11:23 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., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:SUN CARE HOMESFACILITY NUMBER:
197608474
ADMINISTRATOR:STEPHANIE FLORESFACILITY TYPE:
740
ADDRESS:18725 SHOENBORN STREETTELEPHONE:
(818) 384-7456
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 6DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Eduardo Parica & Chita BeltranTIME COMPLETED:
11:40 PM
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On 7/26/22 at 10:15 a.m. Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by staff member. LPA observed covid-19 signage, hand sanitizer and a visitor sign in log. Staff took LPAs temperature and was granted entrance to the facility.

LPA notified the Administrator that an annual inspection will be conducted. LPA met with the designees Eduardo Parica and Chita Beltran. The purpose of the visit was explained and an entrance interview was conducted.

LPA initiated a physical plant tour at 10:30 a.m. This is a four (4) bedroom two (2) bathroom Residential Care Facility for the Elderly. LPA was able to tour the home and did not observe any immediate health and safety concerns. Sufficient PPE supplies were observed. The fire extinguisher was observed in the kitchen area and has a date of purchase of 1/22/2022. Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a comfortable temperature of 75 degrees Fahrenheit. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. Extra towels and linens were readily available. There is a clean covered shaded area in the back yard and there is a pool which has a gate and is kept locked and inaccessible to residents in care.

No deficiencies issued during today’s visit. Report was signed and delivered by designee and an exit interview was conducted.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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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