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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609554
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:54:02 PM

Document Has Been Signed on 09/26/2022 12:54 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 WOODLEYFACILITY NUMBER:
197609554
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:10534 WOODLEY AVENUETELEPHONE:
(818) 274-1809
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 4DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Victor Adekunle/ StaffTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the home and was greeted by facility staff. The LPA had his temperature taken upon entering the home and all covid 19 questions were asked before being allowed entry.

The LPA used the Infection Control tool to complete this annual today. The fire extinguisher was observed in the kitchen and appeared functional.

The facility is currently following their infection control plan and no deficiencies were issued during the visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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