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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002867
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:53:51 PM


Document Has Been Signed on 01/04/2024 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 3DATE:
01/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Denisa Crisan, AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Denisa Crisan, to follow-up on a plan of correction made to the facility on 5/23/2023 to be corrected on 6/16/2023.

During today's visit, LPA took the temperature of the tap water from four faucets. LPA observed the temperature of the water to be 109.5 degrees F for all four faucets.

LPA cleared deficiency during visit.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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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