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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530159
Report Date: 01/30/2024
Date Signed: 01/30/2024 10:12:03 AM


Document Has Been Signed on 01/30/2024 10:12 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, 744 P STREET, MS 9-14-8201
, CA 95814



FACILITY NAME:SUNLIT GARDENS ASSISTED LIVINGFACILITY NUMBER:
365530159
ADMINISTRATOR:AUGAFA, SCARLETTFACILITY TYPE:
740
ADDRESS:9428 19TH STREETTELEPHONE:
(909) 481-2600
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:100CENSUS: 72DATE:
01/30/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Scarlett Augafa, Administrator
Robert Sweet, Applicant
Timothy O'Brien, Applicant		TIME COMPLETED:
09:50 AM
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Component II completion: Successful

Facility Type: Residential Care Facility for Elderly (RCFE)
Application Type: Change in Ownership (CHOW)
Capacity: 100
Census (if any clients in care): 72
COMP II Participants: Scarlett Augafa, Administrator
Robert Sweet, Applicant
Timothy O'Brien, Applicant
Interview Method: Virtual interview (Microsoft Teams)

On January 30, 2024 at 9:00 AM, Applicants and Administrator participated in COMP II. Identification of the Applicants and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicants and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Applicants and Administrator’s understanding of following areas:
1. Facility Operation: License type, client/resident populations, and program.
2. Admission Policies
3. Staffing Requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview conducted with Applicants and Administrator. Report sent via email and informed to return sign copy back to CAB by end of business day today.
SUPERVISOR'S NAME: Joshua MillerTELEPHONE: (916) 651-0571
LICENSING EVALUATOR NAME: Celia PhomphachanhTELEPHONE: (916) 651-0713
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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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