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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700532
Report Date: 01/19/2023
Date Signed: 01/19/2023 01:59:38 PM

Document Has Been Signed on 01/19/2023 01:59 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SUNSHINE RESIDENTIAL IIFACILITY NUMBER:
502700532
ADMINISTRATOR:AMOAH, MARYFACILITY TYPE:
735
ADDRESS:123 PEACH BLOSSOM LNTELEPHONE:
(510) 935-8503
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6CENSUS: 5DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Care staff Avelina Teca TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct Annual/Required visit and met with care staff Avelina Teca and explained the reason for the visit. Care staff Avelina Teca called Administrator Mary Amoah who could not make due to appointments with clients. Administrator Mary Amoah gave permission for care staff Avelina Teca to sign required paperwork. Census: 5

LPA Lund & care staff Avelina Teca toured/Inspected to ensure compliance with Title 22 regulations. There are 4 bedrooms and three bathrooms for the five clients living in the home. LPA observed the bedrooms to be properly furnished, with appropriate lighting. The bathroom was in sanitary condition and properly maintained.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed there are two-days’ worth of perishable and seven days’ of non-perishable food supply on hand. LPA observed toxins inside the home to be locked away and inaccessible to clients. Smoke detectors are operational and care home also has a carbon monoxide detector. Fire extinguishers and first aid kit are maintained and ready for emergency use. Medication storage and found medication to be locked away and inaccessible to clients.

No deficiencies were identified on this visit.

Exit interview held with Administrator Mary Amoah over the phone and copy of report given was left.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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