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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610431
Report Date: 09/18/2024
Date Signed: 09/18/2024 12:43:13 PM

Document Has Been Signed on 09/18/2024 12:43 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 IIFACILITY NUMBER:
197610431
ADMINISTRATOR/
DIRECTOR:		MELIKSETYAN, LUSINEFACILITY TYPE:
740
ADDRESS:9953 LINDLEY AVETELEPHONE:
(747) 218-9141
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 6DATE:
09/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH: LUSINE MELIKSETYANTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 09/18/2024 at 9:05 AM, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia conducted an unannounced, Annual Inspection and met with Caregiver, Kumushai Mizamova. LPA asked for the census, staff and resident files.

The physical plant was toured inside and out at 10:50 am.

Living/Dining Room Area: LPAs observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 77 degrees Fahrenheit with a large television.

Bedrooms: There are six (6) bedrooms. All six (6) bedrooms are used for residents. There are three (3) bedrooms on the right-hand side and three (3) bedrooms on your left-hand. LPAs observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the resident’s room. There are two (2) hallways, the hallway on your right-hand side has two (2) closets, one (1) with extra linen and hygiene and one (1) with a washer and dryer enclosed inaccessible to the residents. The other hallway has two (2) closets filled with linen and extra hygiene.

Medications: There is a black and grey cabinet on your right-hand side of the facility that contains the medication, first aid and files.

There is also a signal system in the facility. There are two (2) fire extinguishers fully charged and expires on April-2025. One (1) is located by the kitchen and the other one (1) is located at the entrance of the facility.

Bathrooms: There are six (6) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. The hot water temperatures were measured within regulations of 105.4 degrees. The showers have non-slip bathmats and grab bars. There are three (3) bathrooms on your right-hand side and three (3) bathrooms on your left-hand side.

LIC809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE AT LINDLEY II
FACILITY NUMBER: 197610431
VISIT DATE: 09/18/2024
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Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets.

The knives/sharps and chemicals are kept next to the kitchen area on your right-hand side, inaccessible to the clients. The chemicals are located under the sink locked and inaccessible to the residents.

Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has no body of water on the premises. There is one (1) gate that is unlocked leading to the outside area towards the street.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is no garage.

Administration: The Liability Insurance was reviewed and will be renewed on 01/2025. There are several Covid 19 signs on the wall, hygiene sanitation signs, Infection Control, House Rules, Personal Rights, Ombudsman, Insurance and Disaster Plans on the wall at the entrance of the facility, Earthquake and Fire Drills were conducted and are located in a separate binder.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

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

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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