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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004080
Report Date: 05/13/2024
Date Signed: 05/13/2024 11:32:17 AM

Document Has Been Signed on 05/13/2024 11:32 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNSHINE CARE HOMEFACILITY NUMBER:
306004080
ADMINISTRATOR/
DIRECTOR:
SHELLY/MICHAEL MARTINEZFACILITY TYPE:
735
ADDRESS:536 HANOVER STREETTELEPHONE:
(714) 828-5008
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 1DATE:
05/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Shelly MartinezTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On May 13, 2024 at 8:00am Licensing Program Analysts (LPAs) Joseph Alejandre and Edward Kim arrived to facility for the required 1-year annual visit. LPAs Alejandre and Kim were greeted and granted entry by staff and met with Administrator (AD) Shelly Martinez. AD Martinez has a valid Administrator Certificate which expires January 14, 2025. LPAs and AD toured the facility. The facility is a single story house with 4 bedrooms (1 is for staff), 2 bathrooms, living room, kitchen, dining room, laundry room, and attached 2 car garage. LPAs observed the fireplace in the living room is screened. LPAs observed puzzles and games for client recreation stored in the living room. In the dining room, clients can listen to the stereo and watch TV. The medication is kept locked in the dining room. The fire extinguisher mounted in the dining room is fully charged. The kitchen is clean and organized. Sharp objects, including the knives, are kept in a kitchen drawer. The cleaning supplies are kept locked under the kitchen sink. The refrigerator has a 2 day perishable and 7 day non-perishable stocked with fruits, vegetables, protein, and grains. It is kept clean and organized. The five burner stove lights up unassisted. The laundry room has a washer and dryer where the cleaning supplies are kept locked in a cabinet. LPAs and AD toured all the bedrooms. The client bedrooms were clean and organized and they had all the required furnishings and bed linens. LPAs inspected both bathrooms. Hot water measured at 106.5 degrees Fahrenheit in the shared bathroom in the hallway. LPAs observed extra linens and towels stored in the hall closet. LPAs and AD toured the backyard. No bodies of water observed. Both backyard exit gates at the side of the house are operational. There is a shaded seating area for the clients to sit outside. No obstacles or hazards observed in the backyard. Carbon monoxide detector and smoke detectors tested are operational. LPAs and AD inspected the garage. The garage is kept locked and inaccessible to clients. The garage is used for storage for emergency food and water and extra supplies. LPAs reviewed the clients P&I money. LPAs verified all 5 clients P&I matched the ledger total. LPAs reviewed client records. No discrepancies observed. LPAs reviewed staff files. No discrepancies observed. LPAs reviewed client medications. No discrepancies observed. No deficiencies observed during this visit. No deficiencies are being cited at this visit. An exit interview conducted with the AD and a copy of the report provided to the AD.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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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