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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607950
Report Date: 11/25/2024
Date Signed: 12/02/2024 03:51:07 PM

Document Has Been Signed on 12/02/2024 03:51 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNLAND MANOR INC.FACILITY NUMBER:
197607950
ADMINISTRATOR/
DIRECTOR:		ARYEH ROSNERFACILITY TYPE:
735
ADDRESS:10540 SHERMAN GROVE AVETELEPHONE:
(818) 352-5941
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 98CENSUS: 97DATE:
11/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Aryeh Rosner, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Leizl de la Cerra and LPA Leslie Ngo-Castaneda conducted an unannounced required 1 year annual inspection. LPAs met with administrator, Aryeh Rosner and explained the reason for the visit.

At approximately 10:00AM, LPA de la Cerra and LPA Ngo-Castaneda conducted a physical plant tour with the administrator.

The facility has three (3) buildings, all were inspected. Required postings were observed in the entry area. The smoke alarms and sprinkler systems are hardwired and interconnected. There are carbon monoxide detectors that function properly. There are (2) fire extinguishers in each of the three buildings. Recently serviced 5/30/2024. 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. Regular bathrooms and common shower rooms had non-skid mat materials in the shower. Hot water temperature in random client's bathrooms from each building were checked. The hot water temperature range from 106.6°F to 108.3°F. LPAs observed cameras installed in the hallways and common areas on all three buildings.

Medications: Locked and secured in two separate medication rooms. LPAs observed that medications were safe, locked and inaccessible cabinet. All medications observed were labeled and maintained, medication records were reviewed for proper documentation. LPAs observed and tested facility signal system/emergency pull cord. Signal call box sound is triggered in the Medication Room and Administrator office, system is observed to function properly. First aid kit is fully stocked with the current manual.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNLAND MANOR INC.
FACILITY NUMBER: 197607950
VISIT DATE: 11/25/2024
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Kitchen area: LPAs observed an adequate amount of non-perishable and perishable food supplies. Food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerators. Frozen food, emergency food and bottled waters are kept in the storage room adjacent to the kitchen.

Laundry room: Laundry rooms are located in building #1 and building #2. Laundry detergents, cleaning solutions, toxins, chemicals and hazardous items were locked and secured.

In addition to the physical plant inspection, clients and staff records were reviewed.


Client's file appeared to be complete and updated. Staff files were also reviewed, staff files appeared to be complete and updated. LPAs reviewed ten (10) client records and six (06) staff records were reviewed to insure compliance.

Administrative: LPAs collected a copy of Certificate of Liability Insurance effective until 03/23/25, copy of Surety Bond effective until 02/12/2025, LIC500 and LIC9020. Facility emergency disaster plan was reviewed. Facility disaster drills are conducted quarterly and was last conducted in 11/06/24. Fire alarm system was last inspected on 05/30/24.


Outside areas: LPAs observed appropriate outdoor furniture, with a covered shaded area for clients.
There are no bodies of water.



Exit interview conducted. Copy of this report emailed to the administrator
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
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