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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700653
Report Date: 06/02/2022
Date Signed: 06/02/2022 12:49:04 PM

Document Has Been Signed on 06/02/2022 12:49 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:
06/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Mary AmoahTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct a proof of correction (POC)/ case management visit. LPA Lund met with Administrator Mary Amoah and explained the reason for the visit.

LPA observed the window screens on the facility and the POC has been corrected. LPA did an POC letter for the facility.

As a result of this visit, no deficiencies are being cited per California Code of Regulations, Title 22.
Exit interview conducted and a copy of this report given at the conclusion of this visit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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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