Sunshine Health Place 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff. Co-Administrator Vana Barberis and Licensee Cilva Toume arrived to assist LPA with visit. Beginning at 10AM, the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and purchased on 04/22/2026. Smoke and Carbon Monoxide detectors were tested and observed functional at the time of the visit. BEDROOMS: There are 7(seven) total bedrooms in the facility; 6 (six) bedrooms are designated for resident use, 1 (one) staff room. The staff room is kept locked and the storage room did not contain any hazardous items. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #4 window blind observed to be not in good repair; unable to cover window completely. Bedroom #4 and #5 door does not close properly (stuck unable to shut all the way). BATHROOMS: There are 3 (three) total bathrooms in the facility; 1 (one) is used by staff, one is a private resident bathroom, and 1 (one) is a hallway bathroom designated for shared resident use. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in all bathrooms; and measured in compliance with regulation (112.4*F-115*F). COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Medications are stored in a locked hallway cabinet. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives are stored in a locked box in the kitchen. GARAGE: Garage was observed locked and contained laundry area, locked chemical storage, extra food, supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a shaded patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan at approximately 11:30AM. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan was observed to be complete and updated annually, as required. RECORD REVIEW: LPA reviewed 5 (five) resident files during today's visit at approximately 12:30PM-2PM. Documents including but not limited to current Physician report, TB test result, Pre placement appraisal, admission agreement, needs and services plan. All required documents observed on file. LPA reviewed 5 (five) Staff files at approximately 2:15-3PM. Staff files observed complete with all required documents including but not limited to fingerprint clearance, current administrators certificates, first aid, CPR and other required training. At approximately 3:30PM, medication were reviewed for policy and procedure implementation. LPA reviewed a random sample of the residents medication. LPA reviewed 2(two) residents medications and medication records. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff. Co-Administrator Vana Barberis and Licensee Cilva Toume arrived to assist LPA with visit. Beginning at 11AM, the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and purchased on 05/23/2024. Smoke and Carbon Monoxide detectors were tested at approximately 03:16PM. All were functional at the time of the visit. BEDROOMS: There are 7(eight) total bedrooms in the facility; 6 (six) bedrooms are designated for resident use, 1 (one) staff room. The staff room is kept locked and the storage room did not contain any hazardous items. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. BATHROOMS: There are 3 (three) total bathrooms in the facility. 1 (one) is used for staff, 1 (one) is a private resident bathroom, and 1 (one) is a hallway bathroom designated for shared resident use. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in shared resident bathroom and measured in compliance with regulation (110.4*F). COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. LPA observed a door stop installed on the fire door in the common area leading to the resident bedrooms. Fire clearance indicates "door stops are prohibited." Medications are stored in a locked hallway cabinet. (Continue to LIC809c). KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives are stored in a locked box in the kitchen. GARAGE: Garage was observed locked and contained laundry area, locked chemical storage, extra food, supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a shaded patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. RECORD REVIEW: LPA reviewed 6 (six) resident files during today's visit. Staff files and additional resident files will be reviewed during annual continuation visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan was observed to be complete and updated annually, as required. INTERVIEWS: During today's visit, LPA interviewed 3 (three) residents and 1 (one) staff. MEDICATION REVIEW: Will be observed during annual continuation visit. Due to time constraints annual inspection will be continued to another day. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 18, 2025

Allegation investigated: Resident sustained multiple falls while in care.

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA met with back-up administrator Vana Barberis and explained the reason for the visit. On 9/18/2023, LPA Elsie Campos started this investigation by conducting interviews with administrator, residents and collecting documentation. On 8/14/2024, LPA Camara conducted a telephone interview with a witness, interviewed staff at 11:46 a.m., and collected more documentation at 11:54 a.m. Residet 1 (R1) fell in August 2023 while using a walker and being assisted by R1's spouse. It was suspected R1 may have had a cardiovascular event which caused the fall but that was never clearly determined by R1's physician. When R1 fell, staff were nearby but not close enough to catch R1. According to staff, prior to R1's fall, R1 was able to walk with standby assistance and a walker. At this time, R1's physical condition has deteriorated and R1 can no longer walk. Witness and Staff stated R1 fell only once at this facility. Based on the information gathered, the allegation R1 sustained multiple falls while in care is deemed Unsubstantiated at this time. Exit interview conducted and report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 14, 2024 · control 29-AS-20230914170537

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:35AM. LPA initially met with facility staff. Licensee Cilva Toume was contacted over the telephone and arrived at 12:37PM. Entrance interview conducted. Beginning at 12:48PM, the LPA, along with Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and purchased on 05/23/2024. Smoke detectors were tested at 02:39PM, Carbon Monoxide detector was tested at 02:40PM. All were functional at the time of the visit. BEDROOMS: There are 8 (eight) total bedrooms in the facility; 6 (six) bedrooms are designated for resident use, 1 (one) staff room and 1 (one) room is utilized for storage. The staff room is kept locked and the storage room did not contain any hazardous items. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. LPA observed full bedrails on 2 (two) residents' beds, however these residents (Resident #1 - R1 and Resident #2 - R2) are not on hospice and do not have valid exceptions on file with the Department. BATHROOMS: There are 3 (three) total bathrooms in the facility. 1 (one) is used for staff, 1 (one) is a private resident bathroom, and 1 (one) is a hallway bathroom designated for shared resident use. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in shared resident bathroom and measured in compliance with regulation. COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be Report Continued on LIC 809-C clean and properly furnished at the time of the visit. LPA observed a door stop installed on the fire door in the common area leading to the resident bedrooms. Fire clearance indicates "door stops are prohibited." Medications are stored in a locked hallway cabinet. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives are stored in a locked box in the kitchen. GARAGE: Garage was observed locked and contained laundry area, locked chemical storage, extra food, supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a shaded patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. RECORD REVIEW: LPA reviewed 3 (three) resident files during today's visit. R1 and R2 do not have valid exceptions on file. Staff files and additional resident files will be reviewed during annual continuation visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan was observed to be complete and updated annually, as required. MEDICATION REVIEW: Will be observed during annual continuation visit. INTERVIEWS: During today's visit, LPA interviewed 1 (one) resident. Additional interviews will be conducted during the annual continuation visit. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalty issued in the amount of $500. Licensee was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 11, 2024