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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001890
Report Date: 10/15/2021
Date Signed: 10/15/2021 02:35:44 PM

Document Has Been Signed on 10/15/2021 02:35 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUNSHINE CARE HOMEFACILITY NUMBER:
347001890
ADMINISTRATOR:JURCA, RODICAFACILITY TYPE:
740
ADDRESS:5010 OLEAN STREETTELEPHONE:
(916) 966-6042
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 1DATE:
10/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Adela Crisan, Administrator TIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Adela Crisan, Administrator and Denisa Crisan, caregiver, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA confirmed there are no residents or staff with a confirmed case or signs/symptoms or Covid. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. There is currently (1) resident at the facility, who is not on hospice. LPA observed resident to be eating lunch in her room.

LPA was advised from Adela Crisan that she is the current Administrator, as of 10/2/2021, and paperwork was sent to the regional office on 9/29/2021 for the change. Adela confirmed that a new license application was submitted to the department on 10/14/2021, for a pending ownership change. LPA took copies of all paperwork recently submitted. LPA confirmed valid Admin Cert # 6049359740- (exp 8/15/2022) for Adela and pending certification for Denisa. LPA confirmed current CPR/First Aid (exp 9/28/2022) for Adela and for Denisa (exp 6/14/2023) LPA and Administrator toured the interior of the facility. LPA observed it to be clean and in good repair. LPA observed various Covid posters throughout. Rooms toured include (2) private bedrooms and (2) shared bedrooms, (2) bathrooms, kitchen, laundry/garage and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 75* F. Fire extinguisher last serviced 9/2021. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap and sanitizer in the bathrooms. LPA obtained updated email address. Discussed vaccination status.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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