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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602592
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:51:07 AM

Document Has Been Signed on 11/01/2023 10:51 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 4FACILITY NUMBER:
198602592
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:1508 W 85TH STREETTELEPHONE:
(818) 274-1809
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 4CENSUS: 0DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Joseph JoseTIME COMPLETED:
11:00 AM
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On 11/01/2023, LPA Antonine Richard conducted a Case Management other visit to the facility above. LPA met with Licensee Joseph Jose. The facility is licensed for four (4) ambulatory clients; currently, there are zero (0) clients in placement and zero (0) staff.

LPA Richard and Joseph Jose toured the inside and outside grounds of the facility. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) clients rooms, two (2) bathrooms, one (1) living area, one (1) dining area and kitchen. The garage is detached from the house in the backyard.

The Licensee, Joseph, stated the facility had no clients since it opened. Licensee stated he was in the process of moving the facility to West Covina. The Licensee stated he did send a letter to Licensing and the Regional Center. LPA did not observe any clients and any staff present during the visit. Licensee stated he will mail the license to Licensing Department by the end of this week. Licensing Department will mail a copy of the closer to Licensee.

The Licensee will forward the email he sent to Licensing to LPA Antonine Richard.

Antonine.Richard@dss.ca.gov

An exit interview held and a copy of the report was provided to Joseph Jose.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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