<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318075
Report Date: 01/23/2023
Date Signed: 01/23/2023 10:28:44 AM


Document Has Been Signed on 01/23/2023 10:28 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:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Merly AgudaTIME COMPLETED:
10:30 AM
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
Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual inspection. LPA was met by Administrator Merly Aguda, and explained the purpose of the visit.

Administrator was in the process of cleaning, preparing documents, and having repairs done at the time of visit. Due to the recent storms, their roof had two leaks. LPA observed a maintenance person repairing 1 out of 2 leaks during the visit. Administrator stated he will be fixing both today.

LPA and Administrator toured the facility inside and out to ensure compliance with Title 22 regulations. LPA observed 3 staff and 10 residents. Residents were observed eating breakfast, watching television, cleaning up the rooms, and using the computer. Staff were observed cleaning the kitchen, bathroom, and common areas. Resident rooms were observed to have necessary furniture and furnishings. Common areas were cluttered; however, staff were in the middle of cleaning. Resident bathrooms were supplied with soap, towels, and a trash can. Hand sanitizers were also observed. Hot water was measured at 108.7*F. Room temperature was measured at 70*F. A pull alarm fire system and fire extinguishers were observed throughout the home to be within compliance. Last check on 04/22/2022. Their is a new patio in the front of the home, which they are hoping to use in the summer. It is equipped with a BBQ grill, a large seating area, and a nice paved walkway. The backyard was free from sharp objects and clear from debris. Shed areas were observed to have old appliances, yard tools, and items not in use. The facility was observed to have emergency supplies, such as a generator, water, canned goods, flash lights, batteries, and blankets.

LPA requested the following documentation: LIC 500, LIC 308, LIC 610D, and Liability Insurance

Per California Code of Regulations (CCR), Title 22, no deficiencies are being cited today. An exit interview was held, and a report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1