197609352-12-26-2023-31-AS-HRAI-CYVTDH-20231226133823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609352
Report Date: 12/26/2023
Date Signed: 12/26/2023 01:39:10 PM

Document Has Been Signed on 12/26/2023 01:39 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNSHINE RESIDENTIAL HOME 3		FACILITY NUMBER:	197609352
ADMINISTRATOR:	JOSE, OYINLOYE AUSTINE		FACILITY TYPE:	735
ADDRESS:	17915 HEMMINGWAY STREET		TELEPHONE:	(818) 666-5319
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 4		CENSUS: 4	DATE:	12/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Mojeed Wale-Rufai, Staff		TIME COMPLETED:	02:00 PM

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At 11:15 a.m. Licensing Program Analysts (LPAs) Huma Rahimi and Angela Panushkina conducted an unannounced annual visit. LPAs met with staff Mojeed Wale-Rufai disclosed the reason for the visit.

LPAs and staff toured the facility inside and out. 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 non-ambulatory clients. The facility serves Regional Center clients from the North Los Angeles County Regional Center (NLACRC).

Entry: LPAs 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.

Bedrooms: The facility has 4 bedrooms, all of which are private. 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 hazard was observed.

Bathrooms: The facility has 2 bathrooms. The client bathroom contained liquid soap, paper towels, handwashing instruction signs, a trash can with a lid, and a non-skid mat in the shower. The shower was in good condition.

Kitchen: LPAs 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 11:40 a.m. LPAs observed a fully charged fire extinguisher hung near the kitchen purchased on 9/26/2023.

Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME 3	FACILITY NUMBER: 197609352
	VISIT DATE: 12/26/2023

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Garage: LPAs and staff entered a locked garage. LPAs observed detergents, three laundry machines, an additional refrigerator and freezer, extra water, emergency supplies, and client belongings.

Back yard: LPAs 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 11:50 a.m. staff tested the dual-functioning smoke and carbon monoxide detector to be functional. Detectors were hard-wired, as LPAs heard 3 out of 3 operational during the test. An additional verbal alert sounded during the test.

Between 11:30am to 01:30pm, LPAs reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023

LIC809 (FAS) - (06/04)

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