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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603283
Report Date: 05/27/2022
Date Signed: 05/27/2022 03:24:58 PM

Document Has Been Signed on 05/27/2022 03:24 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:
05/27/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Victor Mora (Licensee/Administrator)TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kruz Long, Christine Wong, Licensing Program Managers (LPMs) Fernando Fierros, Christine Yee and Victor Mora (Facility Licensee/Administrator), Christina Calleros (Facility Staff) met in the Monterey Park Adult and Senior Regional Office along with Licensee's Attorney Jacob Reinhart via Microsoft Teams Meeting for an Informal Conference to discuss the following issues of non-compliance and the current status of the facility.

During today's office meeting, the following was discussed. the health and safety of facility clients and issues of non-compliance issued during licensing visits to the facility. Licensee to adhere to Title 22 regulations and maintain compliance. Plan of Corrections for citations issued were also discussed. The Department provided Victor Mora a list of staffing agency in the case additional staffing is needed. The Department requested the licensee provide a copy of client's face sheets by 06/01/22.

The following Sections of Title 22 were provided to Licensee during the informal conference:
- Reporting Requirements Section 80061
- Personnel Records Section 80066
- Health Related Services Section 80075
- Criminal Record Clearance Section 80019
- Personnel Requirements 80065
- Client Records 80070
- Administrator Qualifications and Duties 85064
- Food Service 85076

Exit interview conducted with Licensee Victor Mora and a copy of this report provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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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