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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607950
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:53:16 PM

Document Has Been Signed on 09/27/2021 12:53 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 MANOR INC.FACILITY NUMBER:
197607950
ADMINISTRATOR:ARYEH ROSNERFACILITY TYPE:
735
ADDRESS:10540 SHERMAN GROVE AVETELEPHONE:
(818) 352-5941
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 98CENSUS: 92DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Aryeh RosnerTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Yelena Avetisyan conducted an unannounced annual inspection visit to the above facility. At approximately 10:00am LPA met with the Administrator, Aryeh Rosner.

Infection control: LPA conducted reviewed facility mitigation plan (approved on 02/27/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA observed COVID-19 signs posted outside the facility, Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed throughout the buildings. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for clients and staff.

Approximately 10:15 am LPA conducted a physical plant tour with the Administrator.

The facility has three (3) buildings, all were inspected. There is no body of water in the facility. Residents bedrooms appeared to be clean and appropriately furnished for the comfort and safety of residents. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. The facility's smoke alarms are hard wired and had a pull cord system. Some alarm system was last tested on 7/14/2021 by the LAFD. The facility is equipped with sprinkler system which was last tested on 07/09/2021.

LPA observed cameras installed in the hallways and common areas on all buildings. First aid kits are kept in the medication room. Medication were observed to be locked and secured in the locked medication room.

Kitchen area was clean, with an adequate amount of non-perishable and perishable food supplies. Frozen and emergency food and water are kept in the storage room adjacent to the kitchen.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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 2
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 MANOR INC.
FACILITY NUMBER: 197607950
VISIT DATE: 09/27/2021
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Laundry room is located in building #1. Laundry detergents, cleaning solutions, toxins, chemicals and hazardous items were locked and secured in a room in building #2 which can only be accessed from the outside.

Outside areas: LPA observed appropriate outdoor furniture, with a covered shaded area for clients.


There are no bodies of water

In addition to the physical plant inspection, from approximately 11:15 am to 12:15 pm residents and staff records were reviewed. All files appeared to be complete and current. LPA also conducted review of the licensee COVID-19 training program.

Exit interview conducted. Copy of this report emailed to the administrator
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
LIC809 (FAS) - (06/04)
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