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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601808
Report Date: 09/18/2023
Date Signed: 09/18/2023 04:20:40 PM


Document Has Been Signed on 09/18/2023 04:20 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:SUNSHINE HEIGHTS IIFACILITY NUMBER:
198601808
ADMINISTRATOR:DR. ELKE SENEGALFACILITY TYPE:
740
ADDRESS:4907 MAYMONT DR.TELEPHONE:
(310) 902-9919
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:6CENSUS: 5DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:DR. ELKE SENEGALTIME COMPLETED:
04:45 PM
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On 09/18/2023 at 1:48 pm, Licensing Program Analyst (LPA) David España conducted an unannounced required annual visit. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection.

The facility is licensed for six (6) residents of which one (1) may be bedridden. Currently, there are five (5) residents present during today’s visit. LPA met with Administrator, Dr. Elke Senegal and both toured the inside and outside grounds of the facility. During the tour, LPA observed a few required covid postings throughout the facility. All rooms (6) were inspected. All rooms were individual. Bed linen were sufficient in amount, mattresses were observed in good condition, adequate lighting was provided, storage for resident’s personal belongings was observed.

Furniture in the living room observed to be in good condition. There are no weapons on the premises. Residents’ bathrooms (4) were checked, toilets and water faucets worked properly. The water temperature measured between the comfortable temperature of 105F-120F in the facility. LPA toured the kitchen area and observed a 2-day supply of perishable and a 7-day of non-perishable food. Cleaning supplies were observed locked. Centrally stored medications were observed stored in their originally received containers and observed locked and inaccessible to residents in care. One fire extinguisher were observed fully charged in the laundry room.

Outside grounds were toured, no bodies of water were observed. Walkways around the home were generally clear of hazards. Common areas were observed clean; all doorways were free of obstruction.

No deficiencies were cited during this visit.

There was one (1) Technical Assistance: Disaster Preparedness - Technical Assistance: 1569.695(a)(5)

An exit interview was conducted, and a copy of this report was provided to Administrator, Dr. Elke Senegal.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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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