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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005611
Report Date: 06/02/2022
Date Signed: 06/02/2022 12:46:44 PM

Document Has Been Signed on 06/02/2022 12:46 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 FACILITYFACILITY NUMBER:
507005611
ADMINISTRATOR:MARY AMOAHFACILITY TYPE:
735
ADDRESS:420 ROADRUNNER DRIVETELEPHONE:
(209) 894-7465
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6CENSUS: 6DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Mary AmoahTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct an Annual/Required inspection. LPA Lund met with Administrator Mary Amoah and explained the reason for the visit.

LPA & Administrator walked the facility to ensure compliance with Title 22 regulations. There are four bedrooms and two bathrooms for clients. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting and the bathrooms were in sanitary condition and properly maintained as well.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non- perishable food supply on hand. LPA observed knives and toxins to be locked away and inaccessible to clients. LPA observe the backyard of the care home to be free of clutter and debris, and there appeared to be no safety hazards to the clients in care. Smoke detectors are operational and care home also has a working carbon monoxide detector. Fire extinguishers and first aid kits are maintained and ready for emergency use. Care home also conducts fire/disaster drills.

LPA checked medication storage and found medication to be locked away and inaccessible to clients.

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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