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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881227
Report Date: 11/08/2021
Date Signed: 11/08/2021 10:01:40 AM

Document Has Been Signed on 11/08/2021 10:01 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SUNSHINE BOARD AND CARE IIFACILITY NUMBER:
361881227
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
735
ADDRESS:1203 N. IRIS LANETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 10CENSUS: 3DATE:
11/08/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Najeh HamedTIME COMPLETED:
10:10 AM
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Licensing Program Analysts (LPA)s Melody Brown and Amy Goldenberg conducted an unannounced health and safety check for residents residing at the home. LPAs met with Operator Najeh Hamed. LPAs were allowed inside the home.

On 10/21/2021 the department delivered a substantiated finding that unlicensed care was being provided at 1203 N Iris Lane Rialto, CA 92376. Today LPAs conducted a health and safety check of the home and found that Resident 1 (R1) and Resident 5 (R5) were no longer residing at the home. Operator Hamed stated that R1 and R5 already moved out and LPA’s Brown and Goldenberg verified that they are no longer residing at the home. No imminent health/safety concerns observed at the time of visit.

LPAs observed Resident 2 (R2), Resident 3 (R3), and Resident 4 (R4) are still present, but these residents can do their activities of daily living (ADL) independently therefore no issues at this time.

No civil penalties were issued during the visit.

An exit interview was conducted where this report was provided to and discussed with Operator Najeh Hamed.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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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