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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609352
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:33:06 PM

Document Has Been Signed on 08/17/2021 01:33 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 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: 3DATE:
08/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Ifeoluwa Omomiyi/ StaffTIME COMPLETED:
12:45 PM
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Licensing Program Analyst,(LPA), Patrick Shanahan arrived at the facility and was greeted by facility staff. LPA explained the reason for the visit. Staff called the administrator and informed him of the visit. LPA spoke with the administrator, Jose Oyinloye, over the phone and informed him the reason for the visit.

LPA was able tour the home for infection control. LPA's temperature was taken upon entry and the LPA was asked to wash his hands before entering the main part of the home. All four bed rooms were inspected and were observed to be clean.

The facility has a well stocked supply of PPE and staff and residents were observed wearing masks in the common areas of the home.

No health and safety concerns were observed during todays visit.

Exit interview conducted and report emailed to administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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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