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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005611
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:22:09 PM

Document Has Been Signed on 06/13/2024 01:22 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNSHINE RESIDENTIAL FACILITYFACILITY NUMBER:
507005611
ADMINISTRATOR/
DIRECTOR:
MARY AMOAHFACILITY TYPE:
735
ADDRESS:420 ROADRUNNER DRIVETELEPHONE:
(209) 894-7465
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6CENSUS: 6DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator Mary AmoahTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an Annual/Required inspection. LPA Lund met with staff and later with Administrator Mary Amoah and explained the reason for the visit. Census:6

LPA Lund & Administrator Amoah toured/inspected 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 2-day of perishable and 7-day of 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 (6/13/2023) 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. LPA Lund reviewed three clients’ files and three staff, are complying.

No deficiencies cited during visit. Exit interview conducted and a copy of report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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