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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002399
Report Date: 01/31/2024
Date Signed: 01/31/2024 10:26:53 AM


Document Has Been Signed on 01/31/2024 10:26 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SUNSHINE ON OAKDALEFACILITY NUMBER:
455002399
ADMINISTRATOR:DARA BARZINFACILITY TYPE:
740
ADDRESS:1330 OAKDALETELEPHONE:
(530) 222-3383
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 5DATE:
01/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Donna DavisTIME COMPLETED:
10:45 AM
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On 01/31/2024 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Donna Davis and explained the purpose of the visit. LPA Avila and Administrator toured the facility together to ensure the health and safety of residents in care.
Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in locked cabinet. Hot water temperature measured at 116 degrees. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident’s bathroom to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene. Common Areas: These included but are not limited to the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The LPA observed the garage where all cleaning solutions and chemicals are stored and locked cabinet. There are no bodies of water or fire arms on the premises. Record Review: A review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill. The LPA reviewed three (3) staff, and five (5) resident files. All documents reviewed appeared complete and current. Medications: During the facility visit a medications review was initiated. Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Several topics were discussed during today's visit. No deficiencies are being cited. Exit interview conducted and copy of the report provided to Donna Davis.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Ivan AvilaTELEPHONE: (559) 974-4915
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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