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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603974
Report Date: 03/24/2026
Date Signed: 03/24/2026 01:19:08 PM

Document Has Been Signed on 03/24/2026 01:19 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CNRSUNISE BOARDING CAREFACILITY NUMBER:
198603974
ADMINISTRATOR/
DIRECTOR:		KARAPETYAN,HERMINEFACILITY TYPE:
740
ADDRESS:301 W. ASHBY STTELEPHONE:
(818) 425-7406
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 6CENSUS: 6DATE:
03/24/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Claris Sahakian, Licensee and
Hermine Karapetyan, Administrator 		TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Nune Margaryan conducted an announced Pre-Licensing visit at the location. LPA met with Licensee Claris Sahakian and Administrator Hermine Karapetyan. Pre-Licensed Inspection Tool was used. This Pre-Licensing inspection is being conducted as an initial application to be licensed. Facility was approved by the Fire Department 12/16/25 for a total capacity of 6. Fire clearance was approved for four (4) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver was approved for 6 residents.

The facility is in a residential area and is a one story family home. There are four (4) residents’ bedrooms of which two (2) are private, three (3) bathrooms, Office, living / dining area, kitchen, laundry area, front yard, back yard, and detached garage ( used for storage). Dining area has a table and sufficient seating. Living area is fully furnished for residents use. There is also fireplace that has a covering that makes it inaccessible to residents. The residents bedrooms are spacious and will easily accommodate the resident's furnishings. Passageways, walkways, driveway are free of obstructions. Front, back and side areas are free of hazards. There is a shade area set up in the backyard to accommodate 6 residents. The home does not have a pool or any large bodies of water. Bedrooms have all the required furniture such as beds, chairs, dressers, drawers, night stands. Window screens are in good repair and windows/curtains/blinds/shutters are in good repair and operate properly. Bathrooms are clean and have working toilets, wash basins, stand up shower. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket. Extra beddings observed in each bedroom. 2 fire extinguishers are observed fully charged.

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NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2026
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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CNRSUNISE BOARDING CARE
FACILITY NUMBER: 198603974
VISIT DATE: 03/24/2026
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Telephone system is a land line and located in the leaving area. Facility has internet access. Dishes, cups and flat ware are stored in the kitchen, inspected and in good repair. Knives, cutlery and the sharp kitchen utensils are stored in a locked cabinet located in the office. Kitchen appliances are clean and functioning properly. Smoke/carbon monoxide detectors were observed in common areas and in each residents bedroom. Chemicals, laundry detergent observed locked in the shed located in the backyard. The water temperate was tested and measured within the required 105-120 degrees F. Medications along with files will be locked in a file cabinet in the office. No records were reviewed since the home has never been licensed. A first aid kit has been inspected. It contains all the required supplies along with the current first aid manual.

LPA conducted Component III with Licensee. The Pre-licensing is complete, and the facility has no deficiencies.

Exit interview conducted and a copy of this report was provided to Licensee. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
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