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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318075
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:47:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SUNSHINE GLORY CARE HOMEFACILITY NUMBER:
340318075
ADMINISTRATOR:AGUDA, MERLYFACILITY TYPE:
740
ADDRESS:9845 ALTA MESA ROADTELEPHONE:
(916) 687-7874
CITY:WILTONSTATE: CAZIP CODE:
95693
CAPACITY:12CENSUS: 10DATE:
10/21/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Merly AgudaTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a Health and Safety Case Management Visit. LPA Valerio was met with Administrator Merly Aguda and explained the purpose of the visit. Administrator confirmed no residents or staff have displayed any signs or symptoms of COVID-19 in the last 10 day.

LPA Valerio inspected resident bedrooms, resident bathroom, common areas, kitchen, and backyard. Resident bedrooms were furnished with a bed, night stand, trash can, chair, and dresser. Residents who share a room have beds spaced 6 feet apart. Resident bathrooms had liquid soap, hand sanitizer, a trash can, and paper towels. LPA Valerio inspected the kitchen area and food storage areas. The refrigerators and freezers had food items that were labeled and dated. LPA observed the facility to have adequate food supply, enough perishable foods for 2 days and non-perishable foods with 7 days, with an emergency food supply located in a separate freezer and pantry.

LPA Valerio interacted with multiple residents during the visit. Residents were observed watching television in the day room, sitting in the backyard, sweeping the leaves outside, on the computer, and sitting in their rooms. LPA Valerio reviewed 2 residents files and 2 staff files.

LPA Valerio did not observe any health and safety issues during the visit. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a copy of the report was given to Administrator Merly Aguda.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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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