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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002399
Report Date: 01/27/2022
Date Signed: 01/27/2022 12:14:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SUNSHINE ON OAKDALEFACILITY NUMBER:
455002399
ADMINISTRATOR:DARA BARZINFACILITY TYPE:
740
ADDRESS:1330 OAKDALETELEPHONE:
(530) 221-0424
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 6DATE:
01/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:TIME COMPLETED:
12:45 PM
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On 01/27/2022 Licensing Program Analysts (LPAs) Misty Valencia and Shannon Diegoruelas arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain, LPAs met with Donna Davis, Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Ms. Davis and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask, additionally LPA was screened at the front door.

LPAs and Ms Davis toured facility together to ensure health and safety of residents in care. Areas toured include, but are not limited to: common areas, five (5) resident bedrooms, three (3) bathrooms, kitchen, storage areas, and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and Ms Davis completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to Licensee.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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