197607503-7-24-2025-31-AS-MCAA-DJVSTS-20250724141001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607503
Report Date: 07/24/2025
Date Signed: 07/24/2025 02:12:45 PM

Document Has Been Signed on 07/24/2025 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNLAND LIVING		FACILITY NUMBER:	197607503
ADMINISTRATOR/ DIRECTOR:	JURATE EZERSKIENE		FACILITY TYPE:	740
ADDRESS:	11433 COLLETT AVE		TELEPHONE:	(818) 488-1998
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 6	DATE:	07/24/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:52 AM
MET WITH:	Greta Hernandez		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Greta Hernandez, and advised her of the reason for the visit. The administrator, Jurate Ezerskiene, was currently at an appointment. She was unable to attend, but was advised of the visit. At approximately 10:00am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. The smoke alarms are hardwired and battery operated. The carbon monoxide detector, installed at the hallway functions properly. There are two fire extinguishers, maintained near the front entrance. Both are new and fully charged. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. Knives were locked and stored in a kitchen drawer. Cleaning supplies were stored and locked underneath the sink. There is a door at one side of the kitchen entry, and a small gate installed at the other side of the kitchen entry. Properly labeled medications are kept locked in one of the kitchen cabinets. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms utilized by the residents are private. All the bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Staff Rooms: There are two (2) staff rooms which are locked and requires a combination to gain entry. In addition to the staff rooms, there is a living room/break quarters for staff located at the back of the home. There is no resident access to any of these rooms as it requires a combination, or key to gain access.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNLAND LIVING	FACILITY NUMBER: 197607503
	VISIT DATE: 07/24/2025

NARRATIVE

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Bathrooms: There are six (6) bathrooms of which, four (4) are designated for residents' use. There is one bathroom reserved for staff and guests, and another bathroom for staff use only. The four bathrooms designated for the residents are properly supplied and had functional fixtures. Hot water temperature was measured between 111 to 114 degrees Fahrenheit. No cleaning supplies were observed in any of the bathrooms at this time.

Common Areas: These included the living room and dining area. The living room is furnished with a couch, chair, table and television. There is a fireplace, that is properly screened. It is not functional, and no tools present. The dining room table is large enough to seat six (6) individuals. Furniture is in good repair. Hallways and floors were clean and maintained. The auditory alarms on all exit doors were on and functional at the time of the visit.

Surrounding Grounds: Entry/exits were free of obstruction. The backyard has a patio area with furniture appropriate for outdoor use. There is a swimming pool which is fenced all around. The fence is approximately five feet high. Access to the pool is through the laundry area, which is locked at all times. The backyard has two storage buildings, that were observed locked during inspection. There is no garage.

Laundry Room: Access to the laundry area, is in the hallway, between resident rooms. It is kept locked and requires a key or combination code to gain access. All cleaning supplies, laundry detergents, toxins and other chemicals were locked during the day's visit.

Resident Files: Resident files are kept in a cabinet at the living room. LPA conducted a file review of resident records to insure compliance with licensing forms.

Staff Files: Staff files are also kept in a cabinet in the living room area, with the resident files. LPA conducted a file review of staff records to insure compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper storage and documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

LIC809 (FAS) - (06/04)

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