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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700653
Report Date: 01/17/2025
Date Signed: 01/21/2025 11:04:18 AM

Document Has Been Signed on 01/21/2025 11:04 AM - 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 IIIFACILITY NUMBER:
502700653
ADMINISTRATOR/
DIRECTOR:		AMOAH, MARYFACILITY TYPE:
735
ADDRESS:1233 FAWN LILY DRIVETELEPHONE:
(510) 935-8503
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6CENSUS: 2DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Administrator Mary AmoahTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to conduct an Annual/Required visit. LPA Lund and met with care staff and later with Administrator Mary Amoah and explained the reason for the visit. Current Census: 2

LPA Lund and Administrator Mary Amoah toured/inspected the facility to ensure compliance. LPA observed four 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 (7/28/2024 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 files that were in compliance.

No deficiencies were identified on this visit. Exit interview held and copy of report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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