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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002867
Report Date: 02/08/2022
Date Signed: 02/08/2022 12:26:23 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:
02/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Denisa Crisan and Adela CrisanTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 2/8/22 to conduct a Pre-licensing follow-up inspection for corrections noted on 2/2/22.LPA met with licensee and administrator and explained the purpose of the visit. Also present with Metro Fire Inspector. Prior to initiating the pre-licensing 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 confirmed that Masks were worn by staff. Licensee has an exception on file. LPA observed 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.Licensee has record of weekly testing of unvaccinated staff .
Fire inspector observed that the fire door operates properly and proposed options to have a proper door holder.


No deficiencies are being cited as a result of todays inspection. Facility is in significant compliance.
License is pending.
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: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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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