197607503-9-6-2024-31-AS-MCAA-D8USAY-20240906134308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607503
Report Date: 09/06/2024
Date Signed: 09/06/2024 01:43:14 PM

Document Has Been Signed on 09/06/2024 01:43 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNLAND LIVING		FACILITY NUMBER:	197607503
ADMINISTRATOR:	JURATE EZERSKIENE		FACILITY TYPE:	740
ADDRESS:	11433 COLLETT AVE		TELEPHONE:	(818) 488-1998
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 5	DATE:	09/06/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Greta Hernandez, Inga Chavez		TIME COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Greta Hernandez and Inga Chavez. They were advised of the reason for the visit. The administrator, Jurate Ezerskiene, joined shortly after. At approximatel 9:45am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and battery operated. The carbon monoxide detector, installed at the hallway functions properly. The fire extinguisher is located by the kitchen and near the front entrance. It is new and fully charged. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored hidden underneath the kitchen drawer. Cleaning supplies were stored locked underneath the sink. The kitchen is off limits to the clients. There is a door at one side of the kitchen entry, and a small gate installed at the other side of the kitchen entry. Properly labeled medications were maintained locked in one of the kitchen cabinets. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms utilized by residents are private. All the bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Staff Rooms: There are two (2) staff rooms which are locked and requires a combination to gain entry. In addition to the staff room, there is a living room/break quarters for staff. There is no resident access to any of these rooms as it requires a combination, or key to access.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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: SUNLAND LIVING	FACILITY NUMBER: 197607503
	VISIT DATE: 09/06/2024

NARRATIVE

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Bathrooms: There are six (6) bathrooms of which, four (4) are designated for residents' use. One bathroom reserved for staff and guests. Another bathroom for staff only. The bathrooms utilized by the residents were properly supplied and had functional fixtures. Hot water temperature was measured between 106 to 115 degrees Fahrenheit. No cleaning supplies were observed in the bathrooms used by the residents at this time.

Common Areas: These included the living room and dining area. The living room is furnished with a couch, recliner, table and television. The dining area has a round dining room table large enough to seat at least six (6). Hallways and floors were clean and maintained. Passageways were clear of obstruction. The auditory alarms on all exit doors were on and functional at the time of the visit.

Surrounding Grounds: Entry/exits were free of obstruction. The backyard has a patio area with furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool which is fenced all around. The fence is approximately five feet high. The backyard has two storage buildings, that were observed locked during inspection. There is no garage.

Laundry Room: The laundry area has the same door entry as the pool which is kept locked and secured, requiring a key or combination code to gain access. All the laundry detergents and all other cleaning agents, toxins and other chemicals were locked during the day's inspection.

Resident Files: Resident files are kept in a cabinet in the living room area. LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also kept in a cabinet in the living rom area. LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

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.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC809 (FAS) - (06/04)

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