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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700653
Report Date: 01/13/2022
Date Signed: 02/01/2022 03:10:19 PM

Document Has Been Signed on 02/01/2022 03:10 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 IIIFACILITY NUMBER:
502700653
ADMINISTRATOR:AMOAH, MARYFACILITY TYPE:
735
ADDRESS:1233 FAWN LILY DRIVETELEPHONE:
(510) 935-8503
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6CENSUS: 0DATE:
01/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Mary AmoahTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility n unannounced to conduct an Annual Required visit and met with Administrator Mary Amoah and explained the reason for the visit. Administrator Certification for Mary Amoah #6030851735 expires 6/9/22. Current Census: 0

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are 0 residents in care at this time. 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 toxins inside the home to be locked away and inaccessible to future 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. LPA checked future locked medication storage area.
LPA Lund spoke to Administrator Mary Amoah regarding COVID-19.

No deficiencies were identified or issued on this inspection.

Exit interview held and copy of report given at the conclusion of this visit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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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