507005611-7-3-2026-27-AS-CYAG-DVMRN6-20260703130945

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 507005611
Report Date: 07/02/2026
Date Signed: 07/03/2026 01:10:47 PM

Document Has Been Signed on 07/03/2026 01:10 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SUNSHINE RESIDENTIAL FACILITY		FACILITY NUMBER:	507005611
ADMINISTRATOR/ DIRECTOR:	MARY AMOAH		FACILITY TYPE:	735
ADDRESS:	420 ROADRUNNER DRIVE		TELEPHONE:	(209) 894-7465
CITY:	PATTERSON	STATE: CA	ZIP CODE:	95363
CAPACITY: 6		CENSUS: 5	DATE:	07/02/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Alice Teye and Doris Anyanwu		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Unannounced Annual visit made out to this facility on 07/02/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who were met by the facility live-in caregiver, Alice Teye, at this time. A brief interview was conducted with the facility live-in caregiver at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Doris Anyanwu, to inform her that CCL was present at this time. The facility designated Administrator arrived later to this facility. It was learned that this facility was vendorized to be able to accept and retain up to (6) Level 6 residents at any given time. This facility was licensed to serve up to (6) Ambulatory only residents at any given time. Current census was 5 residents, of which all of them, were out of the facility at their respectable day programs at this time. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies which were stored in a closet and were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the facility kitchen cabinet, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility caregiver at this time. A review of the facility Medication Administration Record and dispensing log was conducted.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL FACILITY	FACILITY NUMBER: 507005611
	VISIT DATE: 07/02/2026

NARRATIVE

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Medication cabinet was observed to be locked and made inaccessible to the residents at this time.
Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents.
Administrator Certificate for Doris Anyanwu #6060514735 was observed to have a renewal date of 10/23/2027 at this time.
A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
A tour of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times.
Laundry area was toured. Cleaning supplies, detergents, and bleach were observed to be locked and made inaccessible to the residents at this time.
Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time.
First aid kits were observed to be present and contained all of the required components at this time.
Fire extinguishers were observed to be placed near the kitchen area of this facility and in the garage area and was recently reviewed by the local fire extinguisher company, Assured Fire Extinguisher Company, on 05/27/2026 and in compliance at this time.
A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted.
A review of (5) facility resident files was conducted and noted on the following LIC 858.
A review of (4) facility staff files was conducted and noted on the following LIC 859.
The following forms and documents were requested to be updated and submitted into CCL for review by this LPA:
LIC 308
LIC 400
LIC 500
LIC 610

The following deficiencies were observed and noted on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes.
Civil Penalty in the amount of $100 was assessed on the LIC 421 at this time.
Appeal Rights were printed and a copy was left with the facility representative at this time. Exit Interview

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/03/2026 01:10 PM - It Cannot Be Edited

Created By: Charlie Yang On 07/02/2026 at 01:50 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL FACILITY	FACILITY NUMBER: 507005611
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80077.3(a)

Care for Clients who Lack Hazard Awareness or Impluse Control

(a) If a client requires protective supervision because of running/wandering away, supervision may be enhanced by fencing yards, using self-closing latches and gates, and installing operational bells, buzzers, or other auditory devices on exterior doors to alert staff when the door is opened. The fencing and devices must not substitute for appropriate staffing. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the side gates were unable to close properly and did not allow access from the exterior upon emergencies with responding services which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	The facility designated Administrator stated that the side gates will be repaired/replaced to be able to self latch and close properly at all times. A statement of correction, along with copies of receipts for services rendered, will be completed and submitted into CCL by the due date for review by this LPA.

Type A

Section Cited

CCR

80019(e)(3)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in [1] out of [4] staff was not properly associated to this facility which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	The facility designated Administrator stated that all facility staff files will be reviewed to make sure that they are all fingerprint cleared and properly associated at all times. A statement of correction, along with proof of proper association, will be completed and submitted into CCL by the due date for review by this LPA.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Liza King
NAME OF LICENSING PROGRAM MANAGER:

	Charlie Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 07/03/2026 01:10 PM - It Cannot Be Edited

Created By: Charlie Yang On 07/02/2026 at 01:50 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL FACILITY	FACILITY NUMBER: 507005611
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80065(f)(4)

(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (4) Assistance with prescribed medications which are self-administered. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in that a review of the facility Medication Administration Record did not match up with when medications were dispensed and not properly documented which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	The facility designated Administrator stated that all facility staff responsible for handling, dispensing, and documenting the resident medications will undergo training, for no less than (1) hour in duration, from a vendor designated on the CCL website. A statement of correction, along with proof of updated training, will be completed and submitted into CCL by the due date for review by this LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Liza King
NAME OF LICENSING PROGRAM MANAGER:

	Charlie Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 07/03/2026 01:10 PM - It Cannot Be Edited

Created By: Charlie Yang On 07/02/2026 at 01:50 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNSHINE RESIDENTIAL FACILITY	FACILITY NUMBER: 507005611
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that flooring the dining area was in need of repair. The resident bedroom doors had holes in them that needed to be repaired/replaced. The carpeting in the resident rooms were in need of deep cleaning to remove old stains and signs of excessive wear and the mold in the resident restroom needed to be removed which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/09/2026
	Plan of Correction
1 2 3 4	The facility designated Administrator stated that the resident bedroom doors will be repaired/replaced as necessary. The carpeting in the resident bedrooms will be cleaned and shampooed to remove any signs of excessive wear and stains. The mold present in the resident restrooms will be removed. A statement of correction, along with receipts of services rendered, will be completed and submitted into CCL by the due date for review by this LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Liza King
NAME OF LICENSING PROGRAM MANAGER:

	Charlie Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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