340302290-4-27-2026-27-AS-KVIA-DTJQNJ-20260427121915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340302290
Report Date: 04/27/2026
Date Signed: 04/27/2026 12:20:02 PM

Document Has Been Signed on 04/27/2026 12:20 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SUNSHINE HOME		FACILITY NUMBER:	340302290
ADMINISTRATOR/ DIRECTOR:	HIMAT SINGH		FACILITY TYPE:	735
ADDRESS:	13445 MARENGO ROAD		TELEPHONE:	(209) 745-8566
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY: 15		CENSUS: 15	DATE:	04/27/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:47 AM
MET WITH:	Singh Himat		TIME VISIT/ INSPECTION COMPLETED:	12:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/27/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct the annual inspection. LPA announced herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator (Administrator). LPA met with Licensee /Administrator Singh Himat and a brief interview followed. LPA compared LIC 500 to Guardian roster to ensure that all employees had the required background clearances. All were in compliance at the time of this inspection. LPA observed a food supply of 2-day perishable and 7-day nonperishable. Knives were kept in a locked room and inaccessible to clients. The fire extinguishers were last inspected by Touch Down on 03/16/2026 and were in compliance at the time of this inspection. LPA toured the facility and observed that there was a calendar of activities posted as well as a menu for residents. LPA also observed 2 staff cleaning all common areas, bathrooms, and bedrooms. Resident rooms contained the required furniture, furnishings, and lighting to be in compliance at the time of this inspection. LPA interviewed resident (R1) who stated there was plenty of fresh food, that the residents all got along and that they loved the fresh air. R1 said they got their medications in a timely manner and felt safe at the facility. The medications were inspected next. All medications were stored in a locked cabinet and inaccessible to residents. LPA observed that the pill pack for resident (R2) was not in compliance. The Administer stated that they gave R2 their Monday morning medications from the Sunday PM pill pop. LPA also observed a

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE HOME	FACILITY NUMBER: 340302290
	VISIT DATE: 04/27/2026

NARRATIVE

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discrepancy with R3's medication as compared to the Centrally Stored Medication Log. The Administrator immediately called to verify prescriptions with the pharmacy to resolve the concern. These deficiencies were cited on the LIC 809D page.

The First Aid kit was inspected and LPA provided technical assistance with regard to adding tweezers, otherwise the kit was in compliance.

LPA inspected the three bathrooms all had soap. None had paper towels, however, there was a centrally located hand dryer for residents to use. The hot water was measured 105.3 degrees Fahrenheit and was in compliance at the time of this inspection.

LPA reviewed 1 staff file and 1 resident file. Both were in compliance at the time of this inspection. The Administrator and this LPA toured the exterior of the facility. All windows and gutters were in good repair at the time of this inspection. LPA inspected the two outbuildings. One contained the washer and dryer where staff did all the resident laundry. The other building was a garage for storage of equipment and furniture. Both buildings were kept locked and inaccessible to residents in care.

According to the California Code of Regulations, Title 22, one deficiency was observed during today's visit and it has been cited on the LIC 809D page. A copy of this report has been provided along with APPEAL Rights and an exit interview was conducted with Hamit.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2026 12:20 PM - It Cannot Be Edited

Created By: Kimberly Viarella On 04/27/2026 at 11:33 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE HOME	FACILITY NUMBER: 340302290
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

8005(b)

CCR 80075(b) Health related Services (b) Clients must be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, documentation and interview, the Administrator was not using the pill packages or centrally stored medication and destruction log properly for R1 and R2 making it impossible to determine if all medications were being administered properly. This posed an immediate threat to the health, safety, and personal rights or residents in care.
	POC Due Date: 04/28/2026
	Plan of Correction
1 2 3 4	Administrator stated that they will complete a medication audit of all resident medications with a consultation with their pharmacist who will also provide updated centrally stored medication and destruction log sheets. An update will be emailed to CCLASCPSacramentoSouthRO@dss.ca.gov with a copy to Kimberly.viarella@dss.ca.gov by the close of business on 04/28/26.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:

	Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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