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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002867
Report Date: 02/02/2022
Date Signed: 02/02/2022 05:14:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUNSHINE CARE HOMEFACILITY NUMBER:
345002867
ADMINISTRATOR:CRISAN, ADELAFACILITY TYPE:
740
ADDRESS:5010 OLEAN STREETTELEPHONE:
(916) 966-6042
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 2DATE:
02/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Denisa CrisanTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 2/2/22 to conduct a Pre-licensing referencing the infection control domain. LPA met with staff designee and explained the purpose of the visit. Prior to initiating the prelicensing inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA was screened by facility staff upon entering the facility. Administrator is not present at the facility.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA advised a more robust lock on the knife drawer and kitchen sink cabinet, locking the outdoor shed when not in use and that all toxins and chemicals be secured from residents.

LPA and Denisa completed the infection control recommendations and facility was found to be in substantial compliance at this time. LPA advised staff wear masks at all times at work and record of weekly testing of unvaccinated staff be maintained in staff files as needed.
LPA reviewed one resident and one staff file. Both had required forms. Staff training records not present. LPA requested licensee submit proof of staff training.
LPA will check with fire inspector for approval of fire door and door magnet holder.

Component III review not completed.

No deficiencies are being cited as a result of todays inspection. LPA will follow-up with Licensee that advised issues were addressed. LPA to conduct follow-up visit.
Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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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