197607503-10-7-2023-31-AS-MCAA-CWDSVE-20231007141236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607503
Report Date: 10/07/2023
Date Signed: 10/07/2023 02:13:05 PM

Document Has Been Signed on 10/07/2023 02:13 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: 6	DATE:	10/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Jurate Ezerskiene, Greta Hernandez		TIME COMPLETED:	02:15 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 the administrator, Jurate Ezerskiene, and staff, Greta Hernandez and explained the reason for the visit. At approximatel 9:45am, with the assistance of the administrator, 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 is installed at the hallway functions properly. The fire extinguisher is located in by the kitchen and near the front entrance. It is 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 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 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 this room as it is in the back of the house by the swimming pool. It requires a combination to gain access. LPA did not observe medications is staff room or break quarters of staff.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2023

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: 10/07/2023

NARRATIVE

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Bathrooms: There are five (5) bathrooms of which, four (4) are designated for residents' use. One bathroom reserved for staff and guests. The bathrooms utilized by the residents were properly supplied and had functional fixtures. Hot water temperature was measured between 111 to 118 degrees Fahrenheit. No cleaning supplies were observed in the bathrooms used by the residents.

Common Areas: These included the living room and dining area. The common areas were properly furnished. Hallways, floors were clean and maintained. 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. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The swimming pool is appropriately fenced. It has a combination lock to gain access. There is no garage at this facility. The laundry area has the same entry towards the pool which is kept locked and secured. All the laundry detergents and all other cleaning agents, toxins and other chemicals are observed to be locked and inaccessible to residents in the laundry area. There were storage spaces at the back which were locked and inaccessible to residents.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also 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: 10/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2023

LIC809 (FAS) - (06/04)

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