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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801682
Report Date: 01/09/2026
Date Signed: 01/09/2026 05:57:47 PM

Document Has Been Signed on 01/09/2026 05:57 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNSHINE HEALTH PLACEFACILITY NUMBER:
565801682
ADMINISTRATOR/
DIRECTOR:		SLIM MARONFACILITY TYPE:
740
ADDRESS:1558 NORMAN AVENUETELEPHONE:
(805) 446-3100
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 6DATE:
01/09/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Cilva Toume and Vana Barberis - Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility for a required annual inspection. Upon arrival, the LPA was greeted at the door by staff. Administrator Cilva Toume was contacted by staff. Assistant Administrator Vana Barberis and Licensee Cilva Toume arrived shortly thereafter.
At approximately 10:45am, the LPA began the physical plant tour (inside and outside) to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: The LPA observed common area to be clean and properly furnished at the time of the visit. The LPA observed the fire extinguisher to be fully charged and last purchased on 05/2025. Smoke and carbon monoxide detectors were tested and functioned properly. The temperature is maintained at a comfortable level of 76 degrees F. Cleaning supplies and disinfectants are stored inaccessible under the kitchen sink cabinet, in the garage. KITCHEN: Kitchen/dining area observed. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. Supply of perishable food items good for two days and non-perishable food items for seven days observed at the facility during todays visit. RESTROOMS: Observed restrooms to be clean and sanitary and in operating condition with grab bars and non-skid surfaces during todays visit. Hot water measured at 108.6 degrees Fahrenheit in both restrooms. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Resident #1's bed observed with two half rails position to make full rail (Resident #1 is not on hospice). Staff removed the rails during the visit. Bedroom #6 (near the living) is cleared for ambulatory resident only. Current room #6 is occupied by a non-ambulatory resident. Pending fire clearance update/changes, Licensee stated that she will provide 24hour awake staff, pending transfer of Resident #6 to the room cleared for non-ambulatory upon communicating with resident #1's responsible person and pending fire clearance update/changes. Continue to LIC809c.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
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 5
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE HEALTH PLACE
FACILITY NUMBER: 565801682
VISIT DATE: 01/09/2026
NARRATIVE
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GARAGE: Garage was observed locked and contained laundry area, extra food, supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a patio area with patio furniture including a table, chairs and umbrella for resident use. All passageways were observed to be clear. The facility has a pool, which was observed to be fenced and locked in compliance with regulation.

RECORD REVIEW (1pm-2:30pm) Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All staff and resident records observed on file/updated. All training for staff observed on file/completed.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted on 12/09/2029. Emergency disaster plan was observed to be complete and updated annually, as required.

MEDICATION REVIEW (2:30PM). Medications for three (3) residents were observed. All medications observed were labeled, and properly documented. Medications reviewed and interview with staff revealed that staff is preparing residents medication for the weekend. Bubble pack medications observed punched out from the 8th - 11th. Staff acknowledged understanding the the medications cannot be set-up for more than 24 hours.

INTERVIEWS: During today's visit, LPA interviewed two (2) staff and five (5) residents.


The following deficiencies observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty issued. Exit interview conducted.
Copy of the report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/09/2026 05:57 PM - It Cannot Be Edited


Created By: Zabel Chochian On 01/09/2026 at 03:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE HEALTH PLACE
FACILITY NUMBER: 565801682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)(1)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (1) Nonambulatory persons.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above . Resident #6 is non-ambulatory and in room #6 which is cleared for ambulatory room only. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee stated that she will provide 24 hour awake supervision for resident #6 in room #6 pending communication with responsible person for resident #1 who is currently ambulatory and in a non-ambulatory room. Licensee submit the paper work to initiate the fire inspection for an updated fireclearance for the facility.
Type A
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. Full bedrail observed on the bed of resident #1. Resident #1 is not currently on hospice. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee had staff remove the bed rail during the visit today. Licensee explained that the resident does not need the rail and was just for safety per resident request. Licensee acknowledged understanding full rails is a form of restraint and not allowed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Zabel Chochian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/09/2026 05:57 PM - It Cannot Be Edited


Created By: Zabel Chochian On 01/09/2026 at 03:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE HEALTH PLACE
FACILITY NUMBER: 565801682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(5)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview,record review, the licensee did not comply with the section cited above. All residents medication observed set-up for more than 24 hours. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/12/2026
Plan of Correction
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Licensee conducted in-service with staff. Staff acknowledged understanding the residents medications cannot be set-up for more than 24 hours in advance; medications need to be in its orginal container/bubble pack and not pre set for more than 24 hours.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Zabel Chochian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
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