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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602615
Report Date: 12/22/2023
Date Signed: 12/22/2023 12:11:24 PM

Document Has Been Signed on 12/22/2023 12:11 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
GREATER LA AC/SC, 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:
12/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Comfort OviriTIME COMPLETED:
12:19 PM
NARRATIVE
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LPA made subsequent visit to facility and met with Comfort Oviri DSP to cite for lack of phone service. Wifi and phone is bundled together. LPA discussed the purpose of the visit.

During a complaint investigation o 12/19/2023, LPA Lopez was told by staff and residents that there is no Wifi or phone service at the facility.



LPA cited facility, see 809D for details


Exit interview conducted and copy of report, citation and appeal right provided
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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Document Has Been Signed on 12/22/2023 12:11 PM - It Cannot Be Edited


Created By: Alberto Lopez On 12/19/2023 at 02:26 PM
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: 12/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
HSC
80073(a)

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Telephones. Facilities shall have telephone service on the premises.

This requirement is not met as evidenced by:
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Administrator shall ensure that phone service is restored along with wifi. Administrator shall submit a plan and proof that this has been provided to CCL/LPA by POC due date.
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Staff and Clients stated they have no phone service or wifi since it is bundled together which pose/posses and health and stafety risk to persons in care.
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023


LIC809 (FAS) - (06/04)
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