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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603696
Report Date: 05/14/2024
Date Signed: 05/14/2024 11:43:42 AM

Document Has Been Signed on 05/14/2024 11:43 AM - 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 HOMEFACILITY NUMBER:
198603696
ADMINISTRATOR/
DIRECTOR:
RESURRECCION, FLORMINEFACILITY TYPE:
735
ADDRESS:5109 LORELEI AVENUETELEPHONE:
(562) 895-0772
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 4CENSUS: 2DATE:
05/14/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Flormine Resurreccion - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:59 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Flormine Resurreccion (Licensee) and explained the reason for the visit. The facility is licensed to serve 4 non-ambulatory clients in the age range of 18 through 59, of which 1 may be bedridden. The facility is operating within the scope of its license.

A tour of the single-story facility included four client bedrooms, one staff bedroom, two bathrooms, staff office, kitchen, dining room, living room, backyard, and attached garage. During the tour the following was observed: the front porch and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in both bathrooms and measured at 108.7 degrees F and 107.9 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory clients. Showers also have non-skid materials. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Client beds have the required linen and the linen is in good condition. There is extra clean linen and towels in a hallway cabinet. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility, and were properly operating. There is one fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked under the kitchen sink and are inaccessible to residents. Cleaning supplies and toxins are kept locked in a kitchen cabinet and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in the medication closet. Client and staff files are centrally stored in the medication closet. Client medications are centrally stored in the kitchen. LPA reviewed medication for 2 clients and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 2 clients and 2 staff. LPA observed the administrator certificate for Flormine Resurreccion - 6000617735 with an expiration date of 07/08/2025.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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