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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609867
Report Date: 02/24/2021
Date Signed: 02/24/2021 03:57:14 PM

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:SUNSHINE SENIOR LIVING FACILITYFACILITY NUMBER:
197609867
ADMINISTRATOR:BAKHTAVORYAN, GAYANEFACILITY TYPE:
740
ADDRESS:8455 SPRINGFORD DRTELEPHONE:
(661) 544-4545
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:4CENSUS: 0DATE:
02/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Eduard HakobyanTIME COMPLETED:
03:48 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted a Case Management - Other (Facility Closure) visit at 3:20 pm on this date. The purpose of this visit is to document the closure of this facility which was initiated by the licensee representative, Eduard Hakobyan. The licensee representative informed Community Care Licensing Division (CCLD) that the facility will be closed permanently. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today’s case management visit was conducted as a FaceTime visit.

LPA Spaeth toured the inside and outside of the facility to ensure no resident(s) residing at the facility. During this visit LPA confirmed that no residents are currently residing at the facility.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
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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