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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610209
Report Date: 12/09/2021
Date Signed: 12/09/2021 01:32:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:SUNSHINE SENIOR LIVINGFACILITY NUMBER:
197610209
ADMINISTRATOR:HAKOBYAN, EDUARDFACILITY TYPE:
740
ADDRESS:15955 KALISHER STREETTELEPHONE:
(747) 333-1100
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: DATE:
12/09/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Eduard Hakobyan, Corporate board memberTIME COMPLETED:
01:15 PM
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Facility Type: RCFE Application Type: INITL Capacity:6
COMP II Participant: Eduard Hakobyan Corporate board member
Interview Method: Telephone interview
On 12/9/21, applicant participated in COMP II. Identification of the applicant was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained.
During COMP II, CAB analyst confirmed Applicant's understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness
SUPERVISOR'S NAME: Julia KimTELEPHONE: (916) 430-2347
LICENSING EVALUATOR NAME: Bailey HumesTELEPHONE: (916) 657-2600
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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