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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005793
Report Date: 11/04/2022
Date Signed: 11/04/2022 04:32:23 PM


Document Has Been Signed on 11/04/2022 04:32 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:SUNSHINE DAYS FOR THE ELDERLYFACILITY NUMBER:
306005793
ADMINISTRATOR:QUINTEROS, MAGALYFACILITY TYPE:
740
ADDRESS:13322 PROSPECT AVENUETELEPHONE:
(714) 673-4573
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 4DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Magaly QuinterosTIME COMPLETED:
04:45 PM
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Licensing Program Analyst Michelle Reed arrived at the facility to conduct a Case Management visit. The visit was conducted to discuss an unusual incident report that was sent to the Licensing Office on 10/24/22. Upon arrival, LPA met with Magaly Quinteros. Residents were enjoying activities with other staff.

Client #1 was admitted into the facility on 8/1/22. C1 has a mild intellectual disability, a history of strokes and is total care. C1 uses a wheelchair for mobility and is aggressive and lacks safety awareness.

On 10/17/22, C1's responsible party reported that S1 had hit C1. It is unknown when this incident may have occurred. Records were reviewed and C1 was interviewed at the time of this visit. C1 could not tell LPA what occurred.

According to Administrator Magaly Quinteros, S1 was immediately relieved of duty pending an investigation. S1 denied the allegation and has not returned to the facility.

On 11/3/22, C1 bit Magaly Quinteros on her right arm while Magaly was helping to change C1.

No citations issued at this time.

An exit interview was conducted and a copy of this report was provided to Magaly Quinteros.



SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
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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