198603294-3-8-2024-11-AS-SLEO-D36V2F-20240308150303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603294
Report Date: 03/08/2024
Date Signed: 03/08/2024 03:03:12 PM

Document Has Been Signed on 03/08/2024 03:03 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SUNSHINE ASSISTED LIVING		FACILITY NUMBER:	198603294
ADMINISTRATOR:	MARY MONTIANO		FACILITY TYPE:	735
ADDRESS:	3141 EUCLID AVE		TELEPHONE:	(310) 638-3847
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY: 68		CENSUS: 54	DATE:	03/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Administrator - MARY JANE MONTIANO		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/08/2024 at around 11:40 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Administrator Mary Jane Montiano. LPA explained the purpose of the visit and was accompanied by the Administrator inside and outside the facility during this inspection. This facility is licensed to serve 68 adults ages 18 – 59 years, of which 50 may be non-ambulatory clients. This facility is approved for 5 hospice clients. A total of 54 clients are currently residing in this facility. The Annual Licensing Fees are current. The facility is composed of 2 buildings located in a residential street. The Main Building is composed of 22 client bedrooms, 1 laundry room, 1 dining room, 4 large bathrooms, 1 industrial kitchen, several toilet rooms, main office, lobby, storage rooms, several office spaces, and 1 activity room. The Annex Building is composed of 15 client bedrooms, 3 bathrooms, office spaces, and an employee lounge. Outside grounds consist of 2 parking lots and patio areas with shaded seating.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE ASSISTED LIVING	FACILITY NUMBER: 198603294
	VISIT DATE: 03/08/2024

NARRATIVE

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Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to clients. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises.

LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days.

LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last fire and earthquake drill was conducted on 03/01/2024. First aid kit is fully stocked with manual. The facility completed their Annual Fire Inspection, Testing, & Maintenance on 06/06/2023 certified by the State of California State Fire Marshal. There were several fire extinguishers around the facility. There is a videoconferencing device and landline telephone dedicated for client use.

Several client bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE ASSISTED LIVING	FACILITY NUMBER: 198603294
	VISIT DATE: 03/08/2024

NARRATIVE

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5 staff records were reviewed, 5 out of 5 staff records had required documentation.

5 client records were reviewed, 5 out of 5 client records had required documentation.

No deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted and a copy of this report was left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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