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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603763
Report Date: 07/30/2024
Date Signed: 07/30/2024 11:17:32 AM

Document Has Been Signed on 07/30/2024 11:17 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 4FACILITY NUMBER:
198603763
ADMINISTRATOR/
DIRECTOR:		JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:1053 S PROSPERO DRIVETELEPHONE:
(818) 274-1809
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 4CENSUS: 0DATE:
07/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Jose Oyinloye; Licensee TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tyler Reyes made an announced visit to the facility for the purpose of conducting the Pre-Licensing visit using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Reyes met with Licensee/Administrator Jose Oyinloye and explained the purpose of the visit.

The physical plant consists of a single story structure which includes a kitchen, living room, dining room area, four (4) client bedrooms, two (2) bathrooms, and a front/backyard.

LPA and Licensee conducted a tour of facility and LPA inspected the following:
  • Locked cabinet for medications located in the kitchen.
  • Passageway and doors are unobstructed.
  • Windows are in good repair.
  • Beds have required linen supplies which include: pillowcase, mattress pads, fitted sheet, blanket and bedspreads.
  • Mattress and bedsprings are in good repair.
  • Bedroom furniture which includes: one chair, night stand, adequate lighting for each client, and adequate closet and drawer space.
  • Operable laundry facility
  • Water temperature tested in both bathrooms. Restroom #1 measured at 105.8 degrees F and Restroom #2 measured at 81.8 and at 80.4 degrees F. Restroom #2 did not measure within the required range of 105-120 degrees.

Continued on 809C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE RESIDENTIAL HOME 4
FACILITY NUMBER: 198603763
VISIT DATE: 07/30/2024
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  • Refrigerator, stove, sinks, toilets, and showers operate properly.
  • Cupboards, refrigerator, freezer, stove, and counters are clean.
  • Sufficient amount of personal hygiene supplies are available for clients.
  • Client/Staff records will be inaccessible to unauthorized persons and will be located in a locked file cabinet in the kitchen.
  • Labor information was posted as required.
  • The menu was observed posted in the kitchen.

The physical plant did not meet Title 22 regulations. LPA Reyes to return to ensure facility corrections have been made and that water temperature measures within the required range 105-120 degrees F.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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