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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340302290
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:14:41 AM

Document Has Been Signed on 04/15/2024 11:14 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNSHINE HOMEFACILITY NUMBER:
340302290
ADMINISTRATOR/
DIRECTOR:
HIMAT SINGHFACILITY TYPE:
735
ADDRESS:13445 MARENGO ROADTELEPHONE:
(209) 745-8566
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 15CENSUS: 14DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:21 AM
MET WITH:Himat SinghTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA was met by facility staff and Administrator Himat Singh, and explained the purpose of the visit.

LPA Valerio and Administrator Himat toured the facility to ensure compliance with Title 22 regulations. LPA observed the kitchen area, staff living area, dinning room, resident bedrooms, resident bathrooms, and exterior plant. LPA observed the facility to have a minimum of 2 days of perishable food items, 7 days of nonperishable food items, and a 30 day supply of food. Resident bathrooms were observed to have hand soap, hand sanitizer, toilet paper, paper towels, and a trash can. Resident bedrooms were observed to have necessary furniture. Medications were observed to be locked and inaccessible to residents in care. Last fire inspection was on 04/04/2024. Fire Extinguishers were last serviced on 03/14/2024. The smoking area in the backyard was observed to be clean. LPA observed 3 residents at the facility while the other residents were at Day Program. Staff were observed preparing meals, assist residents, and cleaning the floors.

LPA obtained the following copies for the Regional office file: LIC 500, LIC 610, Surety Bond, Administrator Certificate.

LPA reviewed 4 resident files and 2 staff files. Staff files were observed to be current with up to date training. All staff were fingerprint cleared and associated to the facility roster. Resident files were observed to be current.

Per California Code of Regulation (CCR) - Title 22, no deficiencies are being cited. An exit interview was held with Administrator Himat, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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