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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603283
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:47:08 PM

Document Has Been Signed on 11/16/2021 04:47 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:VICTOR SUNSHINE RESIDENTIAL CAREFACILITY NUMBER:
198603283
ADMINISTRATOR:MORA, VICTOR OLIVER RFACILITY TYPE:
735
ADDRESS:1410 S. RIDLEY AVE.TELEPHONE:
(626) 346-3498
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 4CENSUS: 0DATE:
11/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Christina Calleros TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced case management quarterly visit for the above facility. LPA met with staff Christina Calleros and explained the reason of the visit, and she also assisted with the visit of the facility. LPA inspected the facility inside out. The facility consists of living room, kitchen, dining area, laundry room, staff bathroom, two pantry rooms, three clients bedrooms, one client bathroom, live in staff and bathroom and a detached garage. Currently there's no client live in the facility. Client bedroom#1 and #2 has one single bed, required furniture and linen, sufficient lighting and closet space. Client bedroom#3 has two single beds, required furniture and linen and sufficient lighting and closet space. The hot water temperature tested at 115.3 degrees F which is within Title 22 regulation. The client bathroom is clean and maintained in good condition. All the cleaning products and sharp utensils and knives are locked in the pantry room which are inaccessible to clients. The front and back yard are well maintained. The passageway and exit are free of obstruction. The smoke detectors and carbon monoxide detectors are tested and working properly.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies and no citations issued at this time.

An exit interview was conducted and a copy of the Report was provided to the staff Christina Calleros.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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