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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318075
Report Date: 08/08/2022
Date Signed: 08/08/2022 11:45:46 AM


Document Has Been Signed on 08/08/2022 11:45 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
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:
08/08/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Merly AgudaTIME COMPLETED:
11:50 AM
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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 by Administrator Merly and explained the purpose of the visit. Administrator confirmed that there are 0 residents or staff that have displayed any signs or symptoms of COVID-19 in the last 10 days.

During the visit, LPA Valerio observed residents eating lunch. LPA engaged with residents during the visit. Residents were observed to be happy and enjoying their meal. LPA observed the facility to have sharps locked away in the cabinet while staff cleaned the kitchen.

Staff working were observed to be cleared and finger printed. Staff training files were up to date. LPA requested copies of in-service be sent via fax.

LPA requested the infection control plan be sent to LPA Valerio by COB 08/15/22.

LPA observed the front yard to be under construction. Administrator stated they are planting new trees and going to install a new grill.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An 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: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022
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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