Sunshine Guest Home

Type of visit: Required - 1 Year

On March 27, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry by staff, after stating the reason for the visit. Administrator (AD) Catherine Hsi arrived shortly and assisted with the inspection. The facility is licensed to operate forage range 60 and over, for six (6) non-ambulatory elderly residents, of which one (1) may be Bedridden, with a Hospice Waiver for six (6). The building is a single story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, three (3) bathrooms, living area, dining area, kitchen, sun room, an outdoor covered seating areas, gated pool, and an attached two car garage. During the inspection, LPA Bentley toured inside and outside of the physical plant with staff. There were no obstructions on the premises. A comfortable temperature of 76 degrees F was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of visit and free of clutter and debris. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked and available at the time of visit. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. Bathrooms were found to be clean and operational. The water temperatures in bathrooms measured at 114.8 degrees F to 116.0 degrees F. Continues on LIC 809-C…. The facility last conducted an emergency safety drill on March 15, 2026. First aid kit is maintained and contains all the necessary elements The smoke alarms and carbon monoxide detectors were operable. A working telephone (714-594-3731) remains available, and the facility has a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were available. The facility has one (1) fire extinguisher that was charged, mounted, and serviced on March 4, 2026. Liability Insurance is effective February 14, 2026, and expires on February 14, 2027. During the visit, LPA conducted an audit of three (3) resident files (R1-R3), three (3) staff files (S1-S3), and medication and medication administration records. A total of three (3) resident and one (1) staff was interviewed. Based on today’s observations, no deficiencies were cited during the visit, per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report provided to Administrator (AD) Catherine Hsi at the end of the visit.the state’s words, verbatim · CDSS document, Mar 27, 2026

Allegation investigated: Facility did not provide equipment and supplies for residents.

Licensing Program Analysts (LPAs) Eboni Bentley and Jessica Cho arrived at the facility unannounced to initiate the complaint investigation into the above allegation. LPAs were greeted and granted entry after stating the purpose of the visit to Caregiver (CG) Luis Franco and obtained the following documentation: Resident Roster, Personnel Report Summary, Face Sheets, one of three residents’ Admission Agreements, and one of three residents’ Physician’s Reports. Licensee (LI) Nhut Nguyen arrived shortly after to assist with the investigation and has agreed to submit the remaining documents via email by 5pm July 9, 2025. Regarding the allegation, Facility did not provide equipment and supplies for residents, the following was determined based on observations, interviews, and record review: The resident census is three (3). Based on LPA’s observations of the bedrooms of three residents between 3:00-3:35pm, LPAs observed all required items in the bedrooms which includes the hospital bed, chair, lamp, chest of drawers, and a nightstand. Substantiated LPAs also observed sufficient clean linens in good repair, in each of the bedroom closets, bathrooms, and in the washer and dryer. Also, in the washer and dryer, there were additional towels and linens being washed. There were also seven new sets of unopened packages of linens stored in a closet. Based on the interviews, three out of the three residents, the facility provided all furniture in the room, with the exception of Resident #1 (R1) whose family provided an additional wooden nightstand and wooden chest of drawers, upon move-in on June 29, 2025. Based on interview with LI Nguyen, the facility did not have/provide any chest of drawers in any of the resident bedrooms prior to July 2, 2025. LI confirmed ordering four chest of drawers from Walmart on July 2, 2025 and provided proof of receipt with purchase order date and delivery date of July 2, 2025. LI proceeded to show LPAs four out of four chest of drawers delivered and placed in each residents’ bedroom. It is determined that all three residents were without a dresser until July 2nd, therefore, based on the information gathered during the investigation, through interviews and record review, the preponderance of evidence standard has been met and is deemed SUBSTANTIATED. A deficiency is being cited as per the California Code of Regulations, Title 22, Division 6, Chapter 8 on the attached LIC9099-D. An exit interview was conducted with Licensee Knut Nguyen, and a copy of this report including the LIC9099D, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 8, 2025 · control 22-AS-20250630152805

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3) · Plan of correction due date: Jul 16, 2025

87307 Personal Accomodations and Services (a)(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. This requirement was not met as evidenced by: Based on LPAs' record review and interviews, facility did not provide equipment and supplies for residents, including chest of drawers in the bedrooms for three out of three residents which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 8, 2025

Plan of correction: Proof of purchase order for four dressers were provided with a delivery date of July 2, 2025. Licensee stated that an Acknowlegement of Understanding of the said deficiency will be emailed to LPA by POC due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Lydia Martinez made an announced visit to the facility to conduct a Pre-Licensing inspection. LPA identified herself and was granted entry into the home by Applicant Nhut Thanh Nguyen and Administrator Catherine Hsi. An initial application to operate an Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing on 09/13/2024 for a capacity of six (6) Residents. Administrator Catherine Hsi has an Administrator certificate valid until 08/25/2025. Upon entry, facility appears clean, safe and sanitary. LPA along with Applicant toured the facility and observed the following: Structure: Facility is a one story, 4 bedroom, 2.5 bathroom house with a two car attached garage. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Resident: Two rooms will be single occupancy and other two will be double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet and wash basin. Facility has sanitizer/soap in the bathrooms. Linens & Hygiene Supplies: Facility has adequate bedding, towels and hygiene supplies for Residents in care. Emergency Phone Numbers and Exit Plan: Emergency plan/phone numbers will be located in facility entrance. Food Service: Applicant understands to have a 2 day supply of perishables and a 7 day of non-perishables at all times when Residents are present. There are no Residents present during this inspection. LPA observed ample emergency food and water as well as a facility menu. Smoke Detectors: Smoke detectors/carbon monoxide detectors were tested operational. Fire extinguishers is mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins/Sharps: Facility has secured area for toxins/sharps under kitchen sink and kitchen cabinet. Water Temperature: Tested and hot water temperature was within regulatory requirements. (cont...LIC809C) Medications, First-Aid Kit & Book: First aid kit observed contained all required items, including First Aid Manual. Medication will be stored in dining area locked cabinet and will use a Medication Administration Record. Resident & Staff File: Records to be stored in living room display cabinet. Reading Material, Games, and Equipment: Facility has a variety of board games, music, bingo and cards games. Backyard: LPA observed a swimming pool that is fenced and inaccessible. LPA observed a clean backyard and a covered patio with plenty of seating for Residents and visitors. Exit gate observed unlocked. Fire Clearance: Approved on 10/14/2024. Rooms 1 thru 4 are non-Ambulatory, Room 4 is Bedridden. Facility will have no Live-in staff. The Component III was completed during today's visit. Applicant and Administrator demonstrated and exhibited a clear concise comprehensive knowledge of medication protocols, documentation, and wound preventative care. The Pre-Licensing evaluation has been completed. It appears this facility meets the requirements for licensure. The license will be granted upon completion of a final review and approval from the Application Specialist. An exit interview was conducted with Applicant and the report will be sent to email on file.the state’s words, verbatim · CDSS document, Jan 16, 2025