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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610209
Report Date: 10/16/2024
Date Signed: 10/16/2024 10:28:19 AM

Document Has Been Signed on 10/16/2024 10:28 AM - 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:SUNSHINE SENIOR LIVINGFACILITY NUMBER:
197610209
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN, EDUARDFACILITY TYPE:
740
ADDRESS:15955 KALISHER STREETTELEPHONE:
(747) 333-1100
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 0DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:32 AM
MET WITH:Eduard HakobyanTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Eduard Hakobyan and explained the reason for the visit. The facility is currently and has been vacant since their license was approved. Although license is active, the licensee isn't operating at this time. Licensee is still awaiting process of the Assisted Living Waiver (ALW) application. Also, facility has gone under remodeling to replace/repair the floors in the living room and in room #1, caused by flooding.

At approximately 09:15am, with the assistance of the administrator, LPA took a tour of the physical plant. The facility is a one story building. The smoke alarms are interconnected and battery operated. It is dual with the carbon monoxide detector. The fire extinguisher is located in the kitchen.

Kitchen: The kitchen appliances and fixtures are functional. Because no residents at this time, licensee doesn't store any perishable and non-perishable food. Licensee advised to store a sufficient amount of perishable and non-perishable food items once they admit their clients.

Bedrooms: There are five (5) bedrooms. Four (4) bedrooms are designated for residents' use, and one is for staff. Rooms #1 and #4 are private. Rooms #2 and #3 are shared. Room #1 is having the floors replaced due to flooding, therefore, it is not furnished at this time. Once floors are repaired, furniture will be put back in place. Rooms #2, #3 and #4 were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are two(2) bathrooms. One designated for staff and one designated for residents. The bathroom designated for residents was properly supplied and had functional fixtures. Hot water temperature was measured at 120 degrees Fahrenheit. No cleaning supplies stored in the bathrooms.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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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: SUNSHINE SENIOR LIVING
FACILITY NUMBER: 197610209
VISIT DATE: 10/16/2024
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Common Areas: These included the living room and dining area. Currently the living room floor is under repair due to flooding, therefore the furniture had to be moved at this time. Once repairs are completed, administrator will put back the furniture. The dining room area has a dining room table, large enough to seat up to six (6) individuals. No fireplace or open heaters. Air conditioning and heating unit is centralized. Internal temperature is 72 degrees during the inspection.

Surrounding Grounds: Entry/exits were free of obstruction. Floors in the dining room, kitchen, hallway and bedrooms were mopped and clean. There was furniture appropriate for outdoor use. There is no swimming pool or any other bodies of water. The outdoor area was free of hazards.

Garage: The garage is attached to the building. There is a passageway, through the kitchen. Passageway through the kitchen will be inaccessible to the residents. Garage will be used for extra storage for detergents and cleaning supplies.

Laundry: The laundry area is also located in the garage.

Resident Files: No files to review at this time

Staff Files: No files to review at this time.

Medications: No medications and medication documents to review at this time.

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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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