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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881227
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:19:58 PM

Document Has Been Signed on 12/01/2021 02:19 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, 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: 4DATE:
12/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Najeh HamedTIME COMPLETED:
02:38 PM
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Licensing Program Analyst (LPA) Jennifer Semin conducted a pre-licensing inspection and Component III with the licensee/administrator, Najeh Hamed and House Manager, Ahmad Abdallatef. The application is for an Adult Residential Facility for ten (10) ambulatory residents.

A tour of the pending facility was conducted inside and out. Overall, the pending facility is clean and in new condition. There are no pools, bodies of water, firearms or ammunition. LPA observed the bedrooms to be appropriately furnished with adequate lighting. Bathroom toilets, showers and tubs have grab bars and non-skid mats. The hot water temperature was measured in the client’s bathroom at 112 degrees Fahrenheit. LPA observed food storage and preparation areas are clean and sanitary. Refrigerator and freezer temperatures are maintained at appropriate temperatures. LPA observed a seven (7) day supply of nonperishable food and a two (2) day supply of perishable food. All appliances are clean and operating properly. There is a sufficient supply of linens, towels and personal hygiene items. The first aid kit was reviewed; all items are present including a First Aid Manuel. LPA observed an adequate supply of recreation and leisure items and activities. The backyard is completely enclosed with functioning gate to exit to the street. Outdoor space is suitable for client use that includes a covered patio with a table and chairs. The fire extinguishers have been recently serviced and completely charged. Smoke alarms and carbon monoxide detectors are present and functional. Medications are centrally stored and secured in a locked cabinet. All hazardous materials such as, cleaning and disinfecting supplies, knives and other sharps are locked and inaccessible to residents. All required forms are posted in a common area.

Pre-Licensing is complete, and this facility has no deficiencies.

An exit interview was conducted where this report was discussed and provided to Mr. Hamed.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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