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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318075
Report Date: 08/07/2023
Date Signed: 08/07/2023 09:41:56 AM


Document Has Been Signed on 08/07/2023 09:41 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: 11DATE:
08/07/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Merly AgudaTIME COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a health and safety case management visit. The facility is on quarterly visits due to non-compliance concerns discussed during an office meeting on 02/18/2020. LPA met with Administrator Merly Aguda, and explained the purpose of the visit.

LPA toured the physical plant to ensure compliance with Title 22 regulations. Today, there were 2 staff on shift that were observed to be fingerprint cleared. LPA observed resident bedrooms, bathrooms, common areas, exterior plant, chicken coop, shed, and smoking area. LPA observed resident bedrooms and bathrooms to have necessary furniture and furnishings. Bedrooms were equipped with a bed, chair, dresser, and closet space. Bathrooms were stocked with paper towels, soap, and hand rails. Temperature inside the home is 69*F. LPA observed the front yard to have a new patio, water fountain, and sitting area. Fire extinguishers were up to date and fully charge. No emergency exits were obstructed.

LPA requested to review 2 resident files and 2 staff files. Administrator Merly stated she has yet to receive her certificate; however, she provided proof she sent renewal items to the Department. Staff files and resident files were observed to be current with up to date files.

During the visit, residents were observed eating breakfast, doing chores, doing ADLs, going into the backyard, and going to their outside visits. LPA spoke to multiple residents during the visit.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed. An exit interview was held, and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
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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