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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609554
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:07:20 AM

Document Has Been Signed on 12/11/2024 11:07 AM - 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 WOODLEYFACILITY NUMBER:
197609554
ADMINISTRATOR/
DIRECTOR:		JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:10534 WOODLEY AVENUETELEPHONE:
(818) 274-1809
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 4DATE:
12/11/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Oyinloye Austine JoseTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this meeting was to discuss recent issues of non-compliance.

Present at today's meeting is the following:
· Eva Miller, Licensing Program Manager (LPM)
· Michael Cava, Licensing Program Analyst (LPA)
· Oyinloye Austin Jose– Administrator / Licensee

The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions.

BRIEF HISTORY: The facility has been in operation since licensure on 09/24/2018 and is licensed for four ambulatory only residents age 18-59.

From the date the facility was licensed to present (12/11/24), the Regional Office (RO) received eight complaints reported. Three of these eight have been found substantiated, with the most recent one that was received on 03/26/24. There have been Five Required Annuals conducted and facility appeared to be compliant during these inspections.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME WOODLEY
FACILITY NUMBER: 197609554
VISIT DATE: 12/11/2024
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During today’s meeting, the following matters were discussed:
· Health Related Services
Section 80075(b)(5)(B)- issued 09/19/24
Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Resident 1 (R1) did not receive assistance with their prescribed medication between 11/24/23 through 02/08/24. It was reported that there were about seventeen (17) separate instances, and the reporting agency was able to identify more than thirty-four missed entries by staff for medications prescribed to R1. This posed an immediate health & safety risk to the residents in care.

LPM Miller discussed and expressed concerns regarding R1's medication. The licensee has since addressed the issue by implementing a new medication procedure. LPM Miller has advised the licensee to submit an addendum for the facility's medication procedure in the facility program. This addendum is due to LPA Cava by January 6, 2025.

The Licensee was informed that Community Care Licensing (CCL) shall continue to frequently monitor the facility as often as necessary to ensure the Licensee's compliance with Title 22 Regulations.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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