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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700532
Report Date: 12/07/2023
Date Signed: 12/20/2023 10:02:06 PM

Document Has Been Signed on 12/20/2023 10:02 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 6DATE:
12/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Mary Amoah TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to conduct Annual/Required visit. LPA met Administrator Mary Amoah and explained the reason for the visit. Census: 6

LPA Lund & Administrator Mary Amoah toured/Inspected to ensure compliance with Title 22 regulations. There are 4 bedrooms and three bathrooms for the six 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 2- day worth of perishable and 7- day 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. LPA reviewed two staff & two clients are in compliance.

No deficiencies were identified on this visit.

Exit interview held with Administrator Mary Amoah and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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