197609554-9-19-2024-31-AS-MCAA-D99TQE-20240919145549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609554
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:55:53 PM

Document Has Been Signed on 09/19/2024 02:55 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 WOODLEY		FACILITY NUMBER:	197609554
ADMINISTRATOR/ DIRECTOR:	JOSE, OYINLOYE AUSTINE		FACILITY TYPE:	735
ADDRESS:	10534 WOODLEY AVENUE		TELEPHONE:	(818) 274-1809
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 4		CENSUS: 2	DATE:	09/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:11 AM
MET WITH:	Mojisola Adekunle		TIME VISIT/ INSPECTION COMPLETED:	01:15 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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Mojisola Adekunle and explained the reason for the visit. At approximately 9:30am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. It is licensed to serve level 4 residents. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. There is a carbon monoxide detector located in the hallway, between resident rooms, that functions properly. The fire extinguisher is located in the kitchen. It is fully charged. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and sharps are stored in a locked closet away from the kitchen. Cleaning supplies and toxins are locked underneath the kitchen sink. Bedrooms: There were a total five (5) bedrooms. Four (4) bedrooms are designated for residents' use. There is one (1) bedrooms designated for staff. All four bedrooms designated for resident use are private. All four rooms, in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are three (3) bathrooms. Two (2) are designated for residents' use, and one is reserved for staff. Both bathrooms, for the use of the residents, were properly supplied and had functional fixtures. Hot water temperature was measured at 120 degrees Fahrenheit. There are no cleaning supplies kept in the resident bathrooms.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 2

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 WOODLEY	FACILITY NUMBER: 197609554
	VISIT DATE: 09/19/2024

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
26
27
28
29
30
31
32

Common Areas: These included both living rooms and dining area. Both living rooms were properly furnished. The first living room has two couches. There is a fireplace that is non-functional and blocked off. The second living room has a couch, recliner, additional seating and television. The dining room table is large enough to seat four (4) residents, but can seat up to six (6).

Surrounding Grounds: Entry/exits were free of obstruction. The backyard is large enough to accommodate outdoor activities and exercise. There was furniture appropriate for outdoor use.

Laundry: The laundry area is located adjacent to room #4, and just outside of staff room. There were no cleaning supplies or detergents present during the inspection.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication room is located in between both living rooms. It was observed locked Medication and Medication Records were reviewed for proper storage and documentation. There is a complete 1st aid kit and manual kept in the medication room. Staff and resident records also maintained in the medication room.

Garage: The garage is located in the backyard. It is not connected to the home. The garage was converted into resting areas for staff

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2