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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609352
Report Date: 05/06/2025
Date Signed: 05/06/2025 03:15:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20250501141842
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 3FACILITY NUMBER:
197609352
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:17915 HEMMINGWAY STREETTELEPHONE:
(818) 666-5319
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Toluwalope Jose, Administrator DesigneeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility failed to keep the facility free of pests.
INVESTIGATION FINDINGS:
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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit. LPA met with the staff, Cannta Cornwall, and the Administrator Designee, Toluwalope Jose, was contacted via phone and LPA disclosed the reason for the visit. The Administrator Designee arrived at the facility at 10:12 AM. At 1:00 PM, the Administrator Designee had to leave and designated the staff to sign and receive today's report.

During course of the investigation, interviews and record review were made. At 09:35 AM, LPA requested clients and staff roster. At 9:40 AM, LPA requested copies of pertinent information which include, but not limited to pest control receipts and contract, facility's vehicle information, and etc., relevant to the investigation. At 09:50 AM, LPA conducted a physical plant tour. Between 10:00 AM – 11:00 AM, LPA conducted an interview with the Administrator Designee, Three (3) staff, and one (1) client who was available.

Continue on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 31-AS-20250501141842
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 RESIDENTIAL HOME 3
FACILITY NUMBER: 197609352
VISIT DATE: 05/06/2025
NARRATIVE
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Facility failed to keep the facility free of pests.

It was reported that during a random unannounced visit conducted on 04/23/2025, by a credible witness from North Los Angeles Regional Center ( NLARC), that a cockroach was observed underneath the bathroom sink. To investigate this allegation LPA conducted an interview with the Administrator Designee at 10:20 AM, who confirmed that on 04/23/2025 along with the credible witness observed a live roach underneath the bathroom sink. Interview with three (3) staff between 10:00 AM and 10:30 AM, also stated that a roach was observed during a visit on 04/23/2025. Furthermore, LPA was informed that a pest control company is contracted for a year and the first extermination visit by the company took place on 04/26/2025. Interview with Client #1 (C1) at 10:45 AM, revealed that he/she never witnessed any cockroach in the facility and the facility maintains clean and safe environment. Lastly, during the physical plant tour, LPA did not observe any dead or a live cockroach. Based on the information obtained through interviews, there was enough evidence to support the allegation of facility failed to keep the facility free of pests. Therefore, this allegation is deemed Substantiated.




A deficiency issued and appeal rights explained.

Exit interview conducted and a copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250501141842
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 RESIDENTIAL HOME 3
FACILITY NUMBER: 197609352
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2025
Section Cited
CCR
80087(a)(1)
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80087(a)(1) Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times…(1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by:
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Administrator Designee contracted a pest control company for a year effective on 04/26/2025. Administrator designee will submit initial three (3) months receipts to LPA via e-mail. Deficiency cleared during today's visit.
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Based on interviews, the Administrator failed to ensure that the facility was free from insects and pests, this poses a potential health and safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20250501141842

FACILITY NAME:SUNSHINE RESIDENTIAL HOME 3FACILITY NUMBER:
197609352
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:17915 HEMMINGWAY STREETTELEPHONE:
(818) 666-5319
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Toluwalope Jose, Administrator DesigneeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Facility is not maintaining vehicle that is used for transportation.
INVESTIGATION FINDINGS:
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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit. LPA met with the staff, Cannta Cornwall, and the Administrator Designee, Toluwalope Jose, was contacted via phone and LPA disclosed the reason for the visit. The Designee arrived at the facility at 10:12 AM. At 1:00 PM, the Administrator Designee had to leave and designated the staff to sign and receive today's report.

During course of the investigation, interviews and record review were made. At 09:35 AM, LPA requested clients and staff roster. At 9:40 AM, LPA requested copies of pertinent information which include, but not limited to pest control receipts and contract, facility's vehicle information, and etc., relevant to the investigation. At 09:50 AM, LPA conducted a physical plant tour. Between 10:00 AM – 11:00 AM, LPA conducted an interview with the Administrator Designee, Three (3) staff, and one (1) client who was available.

Continue on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250501141842
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 RESIDENTIAL HOME 3
FACILITY NUMBER: 197609352
VISIT DATE: 05/06/2025
NARRATIVE
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Facility is not maintaining vehicle that is used for transportation.
It was reported that during a random unannounced visit conducted on 04/23/2025, by a credible witness from North Los Angeles Regional Center ( NLARC), that facility vehicle that transports clients was observed with damages. To investigate this allegation At 10:20 AM, LPA conducted an interview with Administrator Designee and was revealed that although a credible witness observed a vehicle with damages on 04/23/2025, the vehicle belongs to a staff and the facility is not using staff personal vehicles for clients’ transportation purposes. Additionally, LPA was informed that the facility does not authorize any staff to use their personal vehicles for clients’ commute purpose. Furthermore, between 10:00 AM and 10:30 AM, LPA interviewed three (3) staff who confirmed the information provided by the Administrator designee. Interview with Client #1 (C1) at 10:45 AM, revealed that all clients are being transported in a well maintained vehicle with no visible damages or safety issues. Lastly, LPA reviewed staff's personal vehicle documents which matched the photos submitted by the credible witness observation and inspection for that day’s visit, and was confirmed that the vehicle observed with damages belongs to a staff and is not being used as facility vehicle to transport clients. Based on interviews and documents review this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and a copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5