361880681-12-1-2023-56-AS-ACON-CY4U9M-20231201142323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361880681
Report Date: 12/01/2023
Date Signed: 12/01/2023 02:23:33 PM

Document Has Been Signed on 12/01/2023 02:23 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SUNSHINE BOARD & CARE		FACILITY NUMBER:	361880681
ADMINISTRATOR:	HAMED, NAJEH		FACILITY TYPE:	740
ADDRESS:	720 N LINDEN AVE		TELEPHONE:	(786) 219-6008
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	12	CENSUS: 12	DATE:	12/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Najeh "Nick" Hamed		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board and Care, Residential Care facility for the Elderly, unannounced conduct an Annual Inspection. LPA was greeted and granted entry by Caregiver/Staff, Tyrone Powell. LPA met with Administrator, Najeh "Nick" Hamed. LPA introduced self and stated purpose of the visit. Administrator accompanied LPA on a tour of the facility and provided records for review. The facility has 8 bedrooms in total. 6 resident rooms, 2 staff rooms, 5 bathrooms, kitchen, dining area, living room, staff lounge, (attached garage) and 2 side pathways on the exterior. LPA conducted a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is approved to have 12 ambulatory residents, 2 of which may be non-ambulatory. At this time, operating at the capacity approved by Community Care Licensing (CCL). Pathways were observed free of clutter and obstructions. The facility was maintained in comfortable temperature. LPA inspected resident bedrooms and found that each room included required furniture such as: mattresses, night stands, adequate storage and sufficient lighting, and seating. LPA inspected resident bathrooms. Bathrooms were observed to orderly and included functional appliances. The facility is equipped with operational smoke detectors and carbon monoxide alarms. Administrator reports disaster drills are conducted on an annual basis. Posters such as; the personal and resident rights, letusknow, and disaster/evacuation plans, facility license, staff and resident roasters were posted in common areas. Cleaning supplies, toxins, sharps, and other dangerous items were observed to be kept secure and inaccessible to residents. LPA observed that resident and staff files are kept secure in a designated securable cabinet in the facility's lobby area. Medications were observed secure and inaccessible to residents. Emergency and first aid kits were observed and readily available for residents in care. Please see LIC9099-C & LIC9099-D

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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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Document Has Been Signed on 12/01/2023 02:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUNSHINE BOARD & CARE	FACILITY NUMBER: 361880681
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87458(a)

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations of resident records, the licensee did not comply with the section cited above in nine, 9 out of twelve, (12) resident files containing out of date Physician's Reports (LIC602) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/05/2024
	Plan of Correction
1 2 3 4	Adminisntrator agrees to assist the 9 residents in making and keeping doctor appointments with their Primary Care Phsyicians to obatin an update Phsician's Reports to maintain in their resident files. Administrator agrees to submit verification of the completed documentation to the Community Care Licensing Office in 30 business days.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUNSHINE BOARD & CARE	FACILITY NUMBER: 361880681
	VISIT DATE: 12/01/2023

NARRATIVE

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Food Service: Non-perishable and perishable food supply is adequate for amount of residents in care. The facility has a posted food menu; which is published on a monthly basis for breakfast, lunch, dinner and snacks. Facility offers its resident a variety of food items such as fruits, canned goods, dry foods, chips, milk, eggs, beverage and frozen meals.. Dishes, cups, and utensils were observed to be clean and in proper storage and in adequate amounts. Emergency food and water supply were also observed.
Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members currently employed in the facility have criminal/fingerprint/background record clearance through the department.
Record Review: LPA reviewed all twelve, (12) resident files for admission agreements, updated physician reports, and needs and services plans. Nine, (9) out of twelve, (12) resident files contained outdated Physician's Reports. LPA also reviewed ten, (10) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Fire extinguisher last inspected February 2023..

Based on observations, interviews and record reviews, deficiencies will be cited per Title 22, California Code of Regulations. An exit interview was conducted. A copy of this report was read/reviewed with Facility Representative; signature acknowledges understanding and receipt of report and attachments.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC809 (FAS) - (06/04)

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