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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610293
Report Date: 11/18/2024
Date Signed: 11/18/2024 12:58:32 PM

Document Has Been Signed on 11/18/2024 12:58 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE AT LINDLEY IFACILITY NUMBER:
197610293
ADMINISTRATOR/
DIRECTOR:		MELIKSETYAN, LUSINEFACILITY TYPE:
740
ADDRESS:9955 LINDLEY AVETELEPHONE:
(747) 218-9141
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 6DATE:
11/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:41 AM
MET WITH:Ruzanna ManukyanTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 11/18/24, at around 9:41AM, Licensing Program Analysts (LPAs) Angelica Segovia and Gina Saucedo conducted an unannounced Annual Required visit to this facility. LPA's met with Charles Mulenga, Caregiver and they called the designee administrator whom arrived later. The facility is licensed as a single-story residence 6 Non-Ambulatory, of which one (1) may be bedridden. Hospice Waiver For two (2). The facility has six (6) bedrooms and six (6) bathrooms currently occupying Six (6) residents. There is no staff room.

LPA's conducted a physical plant tour to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: LPA's observed that kitchen maintains sufficient food supplies for the six (6) residents: seven (7) days of perishable fruits, vegetables, milk, and eggs observed. The kitchen was observed to be clean and sanitary. Laundry washer and dryer in hallway storage closet observed to be in good repair. Cleaning detergents were kept away and inaccessible to residents. There is a supply of canned foods, dried foods, extra water and sufficient emergency food stored in pantry area. Knives/sharps are locked and in the kitchen drawer to the right of the large sink and toxins locked in cabinet underneath large sink. Both observed to be inaccessible to residents.

Medication and associated records stored in a locked file cabinet which were locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record log. First Aid kit was found in living area.

BEDROOMS: There are six (6) bedrooms designated for residents. All bedrooms were clean, properly furnished and had sufficient lighting. Linen storage observed to have adequate supply of linen and towels.

LIC 809C continued...

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE AT LINDLEY I
FACILITY NUMBER: 197610293
VISIT DATE: 11/18/2024
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LIVING ROOM: LPA's observed the living area. Adequate furnishings, sufficient lighting is maintained and was found to be clean with adequate seating for residents.

RESTROOMS: There were six (6) bathrooms designated for residents. Each bathroom has posted “wash your hands” signs and were clean, properly supplied and maintained functional fixtures.



Water temperature for each restroom was recorded at a range of 109.8-113 F.

Smoke alarms and carbon monoxide detectors were present and function properly. There is one (1) fire extinguisher attached to kitchen wall was observed to charged. Extinguisher purchased on 4/20/2024. The other fire extinguisher is located at the entrance of the facility on your left-hand side.

OUTDOOR AREA: In the backyard, a patio table, umbrella and sufficient number of chairs observed with adequate seating for residents. There is no bodies of water present in the facility grounds. There is no garage to the facility.

RECORDS: LPA conducted a complete file review of staff and resident records. Both Staff and Resident records appear to be complete and updated. Disaster drills were conducted.

Required posting such as Administrator License, Personal Rights, Emergency Disaster Plan, Infection Control, Insurance was up to date other postings and displayed properly at the facility on your left hand side.

There was no immediate health and safety hazard observed during the day of inspection.

Exit interview conducted and a copy of this report was provided to facility representative, Ruzanna Manukyan, no citation(s) were issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC809 (FAS) - (06/04)
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