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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609352
Report Date: 08/17/2022
Date Signed: 08/17/2022 01:42:37 PM

Document Has Been Signed on 08/17/2022 01:42 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: 4DATE:
08/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Oyinlowe JoseTIME COMPLETED:
01:45 PM
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At 12:00 p.m. on 08/17/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and staff toured the facility inside and out. The facility was last visited on 08/17/2021 for an annual visit. It is a single story building with 4 bedrooms, 2 bathrooms, kitchen, garage, living room, and a back yard. It has an approved fire clearance for 4 nonambulatory clients. The facility serves Regional Center clients from the North Los Angeles County Regional Center (NLACRC).

Entry: LPA observed a basketball hoop and an unlocked gate at the front yard. Signs regarding the facility’s masking and handwashing policies were hung at the front door. Near the kitchen were postings for the facility sketch, confidential complaints, facility license, administrator certificate, grievance procedure, Emergency Disaster Plan, and personal rights. Screening: LPA was screened for infectious diseases upon entry. A sign for COVID symptoms was posted at the front. The screening station contained a visitor log, digital thermometer, and hand sanitizer. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 12:20 p.m. LPA measured the room temperature to be 75 degrees Fahrenheit. A storage closet near the client bathroom contained board games, extra linens, pillows, and supplies. The living room contained socially distanced furniture in good repair. Electrical wires were gathered in plastic tubing and out of the way. Facility files and medications were locked in a cabinet near the dining room table. Bedrooms: The facility has 4 bedrooms, all of which are private. In Bedroom #2, the top sheet was removed from the mattress. The top sheet was observed lying in the closet. Staff confirmed at approximately 12:20 that the client removed the top sheet at their preference. The exit from Bedroom #3 was unlocked, and the ramp leading out was secure. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. No medications or hazards were observed.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 3
FACILITY NUMBER: 197609352
VISIT DATE: 08/17/2022
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Bathrooms: The facility has 2 bathrooms. The client bathroom contained liquid soap, paper towels, handwashing instruction signs, a trash can with a tight fitting lid, and a non-skid mat in the shower. The shower was in good condition. Two mats with secure rubber backing were on the ground. Around 12:30 p.m. staff confirmed the bathroom mats were recently purchased. Kitchen: LPA observed an adequate supply of perishable and non-perishable food in the kitchen refrigerator and freezer. The stove and hood were clean. Sharp objects and cleaning solutions were locked below the sink. Staff demonstrated how the magnetic locks worked during the visit. At 12:35 p.m. LPA observed a fully charged fire extinguisher hung near the kitchen. Garage: LPA and staff entered a locked garage. LPA observed detergents, three laundry machines, an additional refrigerator and freezer, extra water, emergency supplies, and client belongings. Back yard: LPA observed a couch, a table, and a chair under a covered patio area. Both exit gates were unlocked with inward facing latches. Emergency exit paths were from of obstructions. At 12:45 p.m. staff tested the dual-functioning smoke and carbon monoxide detector to be functional. Detectors were hard-wired, as LPA heard 3 out of 3 operational during the test. An additional verbal alert sounded during the test.

At 1:30 p.m. Administrator confirmed that 4 out of 4 staff present were background cleared and associated to the facility.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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