Sunshine Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with caregiver Emilita Magano and explained reason for visit. Assistant Administrator Maria Tavarez arrived to assist with visit. The facility is licensed to serve 4 Non-Ambulatory Developmentally Disabled Residents ages 60 and over and is approved for 1 Hospice Resident. The facility currently has 1 ambulatory and 3 non-ambulatory residents, which are serviced through Harbor Regional Center. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: 4 Resident Bedrooms, 2 Bathrooms, 1 Staff Room, Living Room, Dining Area, Kitchen, attached garage with laundry, front yard and back yard. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. Extra linen was observed in hallway storage cabinet. The Smoke detectors and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers which is kept in kitchen area. Cleaning supplies and toxic substances were observed to be inaccessible locked under kitchen sink. Sharps and knives were locked in cabinet in kitchen. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 7 days non-perishable foods and 2-day perishable foods for four (4) residents. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The resident bathrooms have the required grabs bars and non-skid mats. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents in backyard. Passageways and exits are free of obstruction. Four staff files reviewed and included Criminal clearance record, and health screening with TB, and CPR/First Aid certificates. Four (4) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. Last fire/earthquake drill was conducted in July of 2026. Infectious control plan and Emergency Disaster Plan was reviewed. Resident medications were reviewed, and R4 was missing one medication. Medications are centrally stored and locked in kitchen. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview was held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Micaella Cisneros (Caregiver) and explained the purpose for today’s visit, shortly after Assistant Administrator Maria Tavarez arrived to assist with visit. The facility is licensed to serve 4 Non-Ambulatory Developmentally Disabled Residents ages 60 and over, and is approved for 1 Hospice Resident. The facility currently has 1 ambulatory and 3 non-ambulatory residents, which are serviced through Harbor Regional Center. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: 4 Resident Bedrooms, 2 Bathrooms, 1 Staff Room, Living Room, Dining Area, Kitchen, attached garage with laundry, front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: Facility maintains the required Infection Control Plan. Operational Requirements: The facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. (Continued on LIC809-C) Staffing: There appears to be sufficient staffing at all times in the facility. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 4 staff files with no issues observed. Flormine Resurreccion Administrator Certificate expired 7/8/25 pending renewal as of 6/3/25 per CCL website. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a cabinet and are in their original containers. LPA reviewed 4 residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Last fire/disaster/earthquake drill was conducted on 7/1/25. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Staff maintain valid CPI certificates. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was emailed to minniebanos@yahoo.com and mariadtavarez@gmail.comthe state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced annual visit at the facility using the CARE Tool. LPA Reyes met with Maria Tavarez (Assistant Administrator) and explained the reason for the visit. The facility is licensed to serve 4 non-ambulatory residents age 60 and over. Facility is approved for 1 hospice waiver. The facility is operating within the scope of its license. A tour of the single-story facility included the living room, dining room, kitchen, staff room, 4 client bedrooms, 2 client bathrooms, front yard, backyard, and attached garage. During the tour the following was observed: the front porch and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 109.4 degrees F Bath #1 and 106.1 degrees F Bath #2 which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in a hallway closet. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility, and were properly operating. There is one fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet and are inaccessible to residents. Cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in the medication cabinet. Residents and staff files are centrally stored in the living room closet. Residents medication are centrally stored in a locked kitchen cabinet. (Continued to LIC 809C) LPA reviewed medication for all 4 residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 4 residents and 6 staff. LPA reviewed P&I funds for 3 residents with staff present. The other resident manages their own funds. LPA interviewed 2 residents and 2 staff. Facility has a valid surety bond and liability insurance. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 29, 2024