197608474-7-18-2024-31-AS-MAGN-D7AU5Y-20240718151731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608474
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:17:43 PM

Document Has Been Signed on 07/18/2024 03:17 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUN CARE HOMES		FACILITY NUMBER:	197608474
ADMINISTRATOR:	STEPHANIE FLORES		FACILITY TYPE:	740
ADDRESS:	18725 SHOENBORN STREET		TELEPHONE:	(818) 384-7456
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	6	CENSUS: 6	DATE:	07/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Chita Beltran- Administrator		TIME COMPLETED:	03:30 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) Mariana Agban conducted an Annual Required visit and inspection of the facility. Upon arrival, LPA was greeted by staff member. Shortly after, LPA met with Administrator Chita Beltran and explained the reason for the visit. A tour of the physical plant was conducted at 10:30 AM. Bedrooms: There were three bedrooms designated for residents' use. All bedrooms were clean, properly furnished and had sufficient lighting. Bathrooms: There were two bathrooms designated for residents' use. Both bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was 110.7 degrees Fahrenheit. Cleaning supplies were kept in locked cabinets. Hallway: There was a large closet full of extra towels and linens that were readily available. Temperature: Facility maintains a comfortable temperature of 73 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas appeared clean and were properly furnished. Surrounding Grounds: Entry/exits were observed to be locked. The outdoor area was clean and free of hazards. 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. Smoke alarms and carbon monoxide: detectors appeared to function properly. There were 2 fire extinguishers at the facility and they were purchased on 08-09-2023. Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and detergents were stored in locked drawers and cabinets. Properly labeled medications were locked in a cabinet near the kitchen. Garage/Laundry area: LPA observed the garage and laundry are to be locked and not accessible to residents. (Continue on 809C)

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUN CARE HOMES	FACILITY NUMBER: 197608474
	VISIT DATE: 07/18/2024

NARRATIVE

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LPA requested copies of the following LIC 500, Resident Roster, copy of the liability insurance, weekly menu, and planned activities calendar. LPA observed that residents are not participating in any activities during the day. LPA observed an old activity calendar hanging on the wall behind many licensing forms. Administrator stated that this activity calendar is old and it's not updated. Administrator was advised to update the activity calendar and engage all residents in outdoor activities.

Exit interview conducted, citations issued and copy of this report delivered.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/18/2024 03:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUN CARE HOMES	FACILITY NUMBER: 197608474
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87219(h)(2)

Planned Activities

(h) Facilities shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: (2) Outdoor activity areas which are easily accessible to residents and protected from traffic. Gardens or yards shall be sufficient in size, comfortable, and appropriately equipped for outdoor use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above. The activity calendar was not updated and there were no activities were held. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/01/2024
	Plan of Correction
1 2 3 4	Administrator will email LPA 2 weeks of activities by the POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

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