<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804662
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:06:10 PM

Document Has Been Signed on 11/22/2024 04:06 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SUNSHINE CARE HOMEFACILITY NUMBER:
370804662
ADMINISTRATOR/
DIRECTOR:
FRANCIS GRACE REYESFACILITY TYPE:
740
ADDRESS:11812 LAKESIDE AVENUETELEPHONE:
(619) 561-0161
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 21TOTAL ENROLLED CHILDREN: 0CENSUS: 15DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator Grace Reyes and Licensee Ian BaylonTIME VISIT/
INSPECTION COMPLETED:
02:40 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 Correia made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Correia was greeted by Administrator Reyes, identified herself, was granted entry into the facility, and explained the purpose of the visit. The facility is licensed to serve twenty-one (21) residents 60 and above; twelve (12) ambulatory and (9) non-ambulatory.

LPA Correia, accompanied by Administrator Reyes, conducted a facility tour both indoor and outdoor of two (2) separate buildings that house residents in care. The facility temperature was 70 degrees Fahrenheit at the time of the visit. The residents’ bathroom's hot water temperature measured with-in regulation requirements. Disinfectants, cleaning solutions, and poisons were inaccessible to residents in care. All resident rooms were equipped with the required furnishings, lighting, and padded mattress covers. Residents’ bathrooms were equipped with grab bars and nonskid flooring in the resident showers, and bathroom fixtures were operational. LPA observed smoke alarms, and carbon monoxide detectors that were in operable condition. Fire extinguishers were present and current on inspections. The facility’s outdoor area was free from obstructions, included a shaded area for residents, and sufficient space for activities and visitations. The facility was stocked with a 2-day supply of perishable and 7-day supply of nonperishable food items. The food was observed properly stored. Knives and sharp objects were stored in locked drawers and inaccessible to residents in care. Medications were stored in a locked cabinet.

[CONTINUED ON LIC 809-C]
Jennifer LottTELEPHONE: (619) 346-3976
Debbie CorreiaTELEPHONE: (619) 407-0894
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNSHINE CARE HOME
FACILITY NUMBER: 370804662
VISIT DATE: 11/22/2024
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
26
27
28
29
30
31
32
[CONTINUED FROM LIC 809]

The facility's last disaster drill was conducted on 11/13/2024. The facility had active liability insurance, and Administrator Reyes has current Administrator certification. LPA observed a sufficient amount of PPE supplies, and a first aid kit. LPA also observed the required postings. Per Licensee Baylon there are no weapons and/or ammunition housed on the facility premises, nor does the facility have any bodies of water. Resident and staff records were complete and up to date.

Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Administrator Reyes and will be provided with a copy of this report and Licensee/Appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2