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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408218
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:49:33 PM

Document Has Been Signed on 01/23/2025 03:49 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SUNSHINE HOME IIFACILITY NUMBER:
366408218
ADMINISTRATOR/
DIRECTOR:
ALBAO, LOURDESFACILITY TYPE:
740
ADDRESS:2158 SYCAMORE AVENUETELEPHONE:
(909) 874-8114
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
01/23/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Lourdes Albao, Administrator and Rosario Nicolas, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:52 PM
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Licensing Program Analyst (LPA) LaVette Farlow arrived at the facility unannounced to conduct a Case Management Visit for health and safety and to conduct an interview of one resident in care.This case management visit is in response to a COMPLAINT #56-AS-20241011163624. LPA was greeted and granted entrance into the facility by Staff, Tessie Martinez. LPA introduced self and stated purpose of the visit. The Licensee Rosario was in the facility and greeted LPA and offer an area to conduct the interview.

During today's visit, LPA interviewed resident, (R2), staff and conducted a tour of the facility. LPA received requested documents from Licensee. LPA did a health and safety check and reviewed documents.

No deficiencies were observed during this visit. An exit interview was conducted where this report was, reviewed, discussed and then provided to Rosario Nicolas, Licensee, and Lourdes Albao, Administrator.
Nedra BrownTELEPHONE: (951) 202-5776
Lavette FarlowTELEPHONE: 951-248-0304
DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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