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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603696
Report Date: 03/13/2025
Date Signed: 03/13/2025 03:19:19 PM

Document Has Been Signed on 03/13/2025 03:19 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
MONTEREY PARK ASC, 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: 4DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Regina Victorio, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mayra Cota, conducted an unannounced required annual visit. LPA met with Regina Victorio, Caregiver, and explained the reason for the visit. Assistant Administrator, Maria Tavarez, arrived thereafter and assisted with the visit.

The facility is licensed to serve four (4) developmentally disabled/non-ambulatory adults ages 18 to 59 years old of which one (1) may be bedridden. The facility is operating within the scope of its license. Clients receive services through Harbor Regional Center. The facility is in a residential area of Lakewood.

LPA and Administrator toured the home and inspected the receiving area, dining area, kitchen/kitchenette area, family room, staff office, four (4) client bedrooms, one (1) staff bedroom, two (2) full client/staff bathrooms, two (2) storage closets, front yard, backyard/patio deck, and attached garage/laundry area. During today’s visit, LPA observed the following:

Inside the home:
· Facility is clean and furniture was observed to be in good repair.
· All doors leading to the front and backyard are equipped with security alarms and were operating properly.
· Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and mattress pads. There is a closet in the receiving area with extra clean linen, towels, and personal hygiene items for clients.
· The water temperature was tested in both bathrooms and measured at 108.4 degrees F in bathroom #1 and 105.4 degrees F in bathroom #2, which is within the required 105 - 120 degrees F.

***Continues on LIC 809C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE HOME
FACILITY NUMBER: 198603696
VISIT DATE: 03/13/2025
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  • Kitchen appliances were clean and were operating at the time of visit.
  • Sharps/knives were locked in a cabinet under the kitchen sink and are inaccessible to clients.
  • Cleaning supplies and toxins were locked in a cabinet in the garage.
  • Sufficient supply of 2-day perishable and 7-day non-perishable food was observed, and additional emergency food supply and water was observed, properly stored in the garage. Food is labeled and kept within expiration limits.
  • Smoke and carbon monoxide detectors are interconnected and were observed throughout the facility. All were tested and observed to be working properly.
  • There is one (1) fire extinguisher located in the kitchen and was observed to be charged. The fire extinguisher was last inspected on 3/5/25. Last fire/safety drill was conducted on 3/1/25.
  • Firs Aid kit was reviewed and contained all required elements. Fist Aid manual is kept on the kitchen counter and is accessible to staff and clients.


Outdoor environment:
  • The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area on the patio deck and is accessible to clients. Patio furniture is in good repair and there is enough seating area for clients.
  • Passageways and exits are free of obstruction.

Medication and record review:
  • Four (4) staff and four (4) client files were reviewed. Staff and client files are kept locked in a cabinet in the kitchen.
  • Medications for four (4) clients were reviewed and were found to be properly dispensed and documented.
  • Client medication is centrally stored in a locked cabinet in the kitchen.
  • Weekly menu and activity calendar is posted by the kitchenette area.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies are cited today. Exit interview conducted with Maria Tavarez, Assistant Administrator and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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