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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602154
Report Date: 11/21/2024
Date Signed: 12/12/2024 08:18:28 AM

Document Has Been Signed on 12/12/2024 08:18 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 2FACILITY NUMBER:
198602154
ADMINISTRATOR/
DIRECTOR:		JOSE, OYINLOYEFACILITY TYPE:
735
ADDRESS:3500 W 67TH STREETTELEPHONE:
(323) 521-6350
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 4CENSUS: 3DATE:
11/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:33 PM
MET WITH:Michael AdigunTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with staff member Michael Adigun and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. There are currently three South Central Los Angeles Regional Center (SCLARC) clients in placement, for the Adult Residential Facility (ARF). The facility's annual fees are current.

There are 12 Domains in the Infection Control Practices that will be observed and reviewed. "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

The facility is a single-story family home located in a residential neighborhood. Staff member Michael and LPA Bunker made a complete tour of the facility which included: Living room, dining room, kitchen, breakfast area, 3 bedrooms, 1 bathroom, laundry area in the kitchen, detached garage, patio/shaded area, and indoor/outdoor activity areas.

Due to time constraints, LPA Bunker was unable to complete the visit scheduled for today.

There were no deficiencies cited.

An exit interview was conducted.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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