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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700532
Report Date: 07/24/2023
Date Signed: 07/24/2023 11:57:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230515111606
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: 4DATE:
07/24/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dinah Ferolino, Direct Service ProviderTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not prevent the lawn from becoming overgrown.
INVESTIGATION FINDINGS:
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LPA Campbell arrived unannounced on 07/24/23 at 8 am to investigate the above-mentioned allegations. LPA met with Direct Service Providers (DSPs) Concepcion Ferolino and Dinah Ferolino and stated the purpose of the visit. LPA observed the exterior physical plant and found that the deficiency had been addressed and the grass had been cut.

However, based on pictures obtained, observations , and interviews, it was found that the yard had been allowed to become overgrown. Therefore, based on the above aforementioned information, the preponderance of evidence standard has been met therefore the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC-9099D. Appeal rights were provided. An exit interview was conducted, and a copy of the report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20230515111606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNSHINE RESIDENTIAL II
FACILITY NUMBER: 502700532
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2023
Section Cited
CCR
80087(c)
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Building and Grounds. (c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
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The facility will mow the grass. This deficiency was addressed prior to today's visit and the Administrator pays someone to mow the grass and take care of the garden. The administrator will provide a statement of understanding to be sent to LPA Campbell at renee.campbell@dss.ca.gov.
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Based on observation and pictures obtained, the lawn had become overgrown.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2