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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602615
Report Date: 11/29/2022
Date Signed: 11/29/2022 05:20:19 PM

Document Has Been Signed on 11/29/2022 05:20 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE RESIDENTIAL HOMEFACILITY NUMBER:
198602615
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:1159 E 68TH STTELEPHONE:
(323) 305-3552
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 4CENSUS: 4DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Precious Brown TIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with DSP Matthew Olusole and explained the reason for the visit. Shortly after, the house manager Precious Brown arrived. LPA used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures, observed food supply, and reviewed clients and staff files.

The facility is a single story house and its located in a residential neighborhood area. The facility is included: Living Room, Dining area, kitchen, four clients bedrooms, two bathrooms, laundry room and a detached garage. All 4 clients bedrooms were toured. Each bedroom has one bed, required bed linen and furniture and sufficient closet space and lighting. LPA observed Bedroom#2 does not have a curtain. All 2 bathrooms were toured and they are clean, sanitary and in a good working condition. The hot water temperature in both bathrooms were tested between 150.6 and 154.5 which is beyond the required 105-120 degrees F. The refrigerators in the kitchen and the garage and garage cabinet has sufficient for two days perishable and seven days non perishable food supply. All the kitchen appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all working properly.

LPA reviewed 4 clients files to confirm emergency contact is updated. LPA was not able to review staff files as its not in the facility.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, facility is disinfected twice or three times a day. restrooms have sufficient soap, paper towels, and signs, PPE supplies are sufficient for more than 30 days.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided to House Manager Precious Brown.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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Document Has Been Signed on 11/29/2022 05:20 PM - It Cannot Be Edited


Created By: Christine Wong On 11/29/2022 at 10:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE RESIDENTIAL HOME
FACILITY NUMBER: 198602615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
80088 (e) (1) Furniture, Fixtures, Equipment and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, LPA inspexcted both bathrooms and the hot water tested between 150.6 and 154.5 degrees F which pose an immediate risk to clients in care
POC Due Date: 11/30/2022
Plan of Correction
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The administrator will fix the hot water heater immediately and send the seven days hot water log to LPA by 12/6/22
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christine Yee
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/29/2022 05:20 PM - It Cannot Be Edited


Created By: Christine Wong On 11/29/2022 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE RESIDENTIAL HOME
FACILITY NUMBER: 198602615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(c)
80066 (c) Personnel Records
(c) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation and LPA was not able to review staff files due to the staff files was not in the facility and it was with administrator
POC Due Date: 12/06/2022
Plan of Correction
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The administratrator will ensure all staff records shall be available for licensing agency to inspect and the administrator will come up a plan and send the plan to LPA by POC due date.
Type B
Section Cited
CCR
80072(a)(2)
80072 Personal Rights

(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, LPA observed Bedroom#2 does not have a curtain which posed a potential risk to clients in care
POC Due Date: 12/06/2022
Plan of Correction
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The administrator will put the curtain back to the Bedroom#2, and send the picture to LPA by POC Due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christine Yee
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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