SUNSHINE HOME CARE

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed that there were two medications stored in an hallway cabinet with a broken lock.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction The Administrator stated that she will conduct an in service training with all staff regarding the storage of medications. The Administrator agreed to provide LPA proof of the in service training via email or fax by POC date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed the facility did not complete an emergency disaster drill in the previous quarter with the last emergency disaster drill completed on November 25, 2025.

Official plan of correction

POC Due Date: 04/17/2026 Plan of Correction The Administrator stated that she will conduct an emergency disaster drill with all staff. The Administrator agreed to provide LPA proof of the emergency disaster drill via email or fax by POC date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed that Resident #4 (R4) has full bed rails, however, R4 is currently not receiving hospice care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction The Administrator removed the full bed rails at time of visit and stated that she will obtain an order for half rails for R4. The Administrator agreed to provide LPA the half rail order for R4 via email or fax by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health and safety risk to persons in care. During a tour of the exterior portion of the facility, LPA observed two laundry detergent containers left unattended by the unattached garage. AD immediatey locked the chemicals in the garage during the visit.

Official plan of correction

POC Due Date: 04/25/2025 Plan of Correction AD agreed to conduct an in house training with staff regarding the proper storage of chemicals and toxins. AD agreed to submit proof of training to LPA via email or fax by POC date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During staff file review, LPA observed that zero out of four staff have a Health Screening report on file.

Official plan of correction

POC Due Date: 05/09/2025 Plan of Correction AD agreed to get Health Screening reports for the four staff that work at the facility. AD agreed to submit the Health Screening reports for the four staff to LPA via email or fax by the POC date.

Official classification

Type A

Official code

87606(b)

Regulation authority

CCR

What the official deficiency says

(b) A facility shall notify the local fire jurisdiction within 48 hours of accepting or retaining any bedridden person, as specified in Health and Safety Code Section 1569.72(f). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above. LPA Kim and LPM Montoya observed two (2) resident files, R4 and R5, are bedridden. However facility does not have fire clearance for bedridden residents. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2024 Plan of Correction Licensee agreed to the section cited above. Licensee will submit a LIC 200, with $25, and obtain fire clearance for bedridden. Proof of correction of the above deficiency will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/27/2024.

Official classification

Type B

Official code

87208(d)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (d) A licensee who accepts or retains bedridden persons shall include additional information in the plan of operation as specified in Section 87606(f). This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and interview with licensee, facility does not have a plan of operation for accepting and retaining bedridden persons.This poses a potential health, safety, and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/03/2024 Plan of Correction Licensee agrees to the section cited above. Licensee agrees to update in writing the new plan of operation to include information for accpeting and retaining bedridden persons and send documents to CCLD via email to edward.kim@dss.ca.gov by POC due date May 3, 2024.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA Kim observed and measured the hot water temperature at 134 degrees F in Resident 4 bathroom, 132 degrees F in shared bathroom, and 137.6 degrees F in Resident 2 bathroom.This poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Administrator agrees to the section cited above. The Licensee will adjust the water temperature and will create a temperature log for each bathroom and measure the temperature every two hours from April 17, 2024 5:00pm until April 18, 2024 5:00pm. Proof of correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date April 18, 2024.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA Kim observed and took photos of a gallon of Clorox, kirkland laundry supply, and a bottle of Fabulouso cleaner in the laundry room, a bottle of lysol in resident 3 bathroom floor, and dishwasher liquid soap and other cleaning supplies unlocked under the kitchen sink. This poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction The administrator agreed to keep the above items inaccessible to residents. Proof correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date April 18,2024.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed and took photos of the outdoor shed with broken panels which contain two hand saws and one shears.This poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction The administrator agreed to keep the above items inaccessible to residents. Proof correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date April 18,2024

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed and took photos of all four burner stoves were not operating, kitchen cabinet drawers above the stove do not close properly, the garage used for storage is not clean and organized, and wood scraps and glass panels outside of the garage, backyard, and back porch. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator agreed to comply to this cited section. Proof of correction of the above deficiencies wil be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/26/2024.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. LPA Kim observed facility structure is not consistent with filed floor plan and clearance by having a Laundry room in a hallway and a bathroom in the garage. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator agreed to submit LIC200, application fee of $25, and updated Facility Sketch (floor plan) and will also submit proof of the building permits for garage alteration and hallway alteration. Proof of correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/26/2024.

Official classification

Type B

Official code

1569.319(a)

Regulation authority

HSC

What the official deficiency says

(a) A licensee of a facility that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for resident use. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. LPA Kim interviewed licensee about the facility not having an internet accessible device that residents can use. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator agreed to provide an internet accessible device devoted for residents' use. Proof of correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/26/2024.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed and took photos of expired (on January 4, 2024)Pillsbury Turkey Sugar Cookie Dough, expired (on February 15, 2024) Elbow Macaroni box, and expired (February 15, 2024) blueberry muffin mix box.This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator agreed to dispose expired food. Proof of correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/26/2024.

Official classification

Type B

Official code

87705(c)(5)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observationand record review, the licensee did not comply with the section cited above in Residents with Special Health Needs - Type B: 87705(c)(5)(A) - R4's latest Physician Report is on 2/16/2023. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator agreed to submit a current Medical Assessment for R4. Proof of correction of the above deficiencies will be submitted to CCLD via email to edward.kim@dss.ca.gov by the POC due date, 4/26/2024.

Official classification

Type A

Official code

87305(a)(b)

Regulation authority

CCR

What the official deficiency says

Alterations to Existing Building or New Facilities(a) Prior to construction or alterations, all facilities shall obtain a building permit. (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by: Based on observation, facility did not comply with regulation cited above. LPA observed facility structure is not consistent with filed floor plan and fire clearance. This poses an immediate health and safety risk to persons in care.

Official plan of correction

AD to submit LIC200, application fee of $25 and updated Facility Sketch (floor plan) and will also submit proof of the building permits for the garage alteration and patio alteration by 6/23/2022.

Deadline recorded: Jun 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation -(a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by: LPA observed broken dressers, old bikes, wood scraps, and plastic bins, around the house, side of garage and under the house patio. This poses a potential health and safety risk to residents in care.

Official plan of correction

AD is to ensure the facility is clean, safe, sanitary and in good repair at all times. Agreed to submit proof (pictures) to CCLD on or before 07/01/2022 per section cited.

Deadline recorded: Jul 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

General Food Requirements (8) All food shall be of good quality...Food in damaged containers shall not be accepted, used or retained... This requirement is not met as evidenced by: LPA observed expired food in pantry (Hungry Jack powdered smashed potato expired 7/2021; Pretzels expired 7/2021; Chocolate chip cookies expired 1/21/2022; Balsamic expired 12/2021; Hallway freezer was observed with freezer burned vegetable bags and freezer burned meat. This poses a potential health and safety risk to residents in care.

Official plan of correction

AD to ensure facility's food is of good quality at all times. Expired/freezer burned food was immediately removed at the time of visit. AD to clean out refrigerator, freezer and pantry and submit proof (pictures) to CCL on or before 06/23/2022.

Deadline recorded: Jun 23, 2022. A deadline is not proof that correction was completed.