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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002399
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:02:54 PM


Document Has Been Signed on 03/07/2023 03:02 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,
, CA



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: 5DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Donna Davis - AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA met with 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask and gloves. Additional LPA was screen at the front door before entering the facility.

LPA Wallace and administrator 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. LPA and administrator completed the full care tool and facility was found to be in substantial compliance at this time.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 108.2 degrees Fahrenheit in bathroom sink and signs are posted over every sink regarding hot water Fire Extinguishers were inspected on 11/6/2022 and in compliance. Smoke and carbon monoxide detectors are in compliance with fire safety. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed two (2) client and two (2) staff files, including criminal record clearances. LPA reviewed Fingerprint clearance and associations to the facility. First aid kit was checked and is complete.

Deficiency is cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Corrections (POC's) by Plan of Correction date may result in civil penalties.

Exit interview and copy of the reports and appeal rights left with administrator.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023
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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