197610293-3-18-2024-31-AS-RCOR-D3GT7Z-20240318142934

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610293
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:29:46 PM

Document Has Been Signed on 03/18/2024 02:29 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:	SUNRISE AT LINDLEY I		FACILITY NUMBER:	197610293
ADMINISTRATOR:	MELIKSETYAN, LUSINE		FACILITY TYPE:	740
ADDRESS:	9955 LINDLEY AVE		TELEPHONE:	(747) 218-9141
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 6	DATE:	03/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ruzanna Manukyan		TIME COMPLETED:	02:45 PM

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On 03/18/24, at 10:00AM, Licensing Program Analysts (LPAs) Raymond Comer and Gina Saucedo conducted an unannounced Annual Required visit to this facility. LPA'S met with Charles Mulenga, caregiver and they called the designee administrator whom showed up like twenty-minutes (20) later. The facility is licensed as a single-story residence 6 Non-Ambulatory, of which one (1) may be bedridden. Hospice Waiver For two. The facility has six (6) bedrooms and six (6) bathrooms currently occupying 6 residents. There is no staff room.

LPA's conducted a tour at 11:55 am of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: LPA's observed that kitchen maintains sufficient food supplies for the six (6) residents: seven (7) days of perishable fruits, vegetables, milk, and eggs observed. The kitchen was observed to be clean and sanitary. Laundry washer and dryer in hallway storage closet observed to be in good repair. Cleaning detergents were kept away and inaccessible to residents. There is a supply of canned foods, dried foods, extra water and sufficient emergency food stored in pantry area. Disaster drills were last conducted on 1//29/2024.

Knives are locked in kitchen drawer to the right of the large sink and toxins locked in cabinet underneath large sink. Both observed to be inaccessible to residents. Medication and associated records stored in a locked file cabinet which was locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record log. First Aid kit was found in living area.

BEDROOMS: There are six (6) bedrooms designated for residents. All bedrooms were clean, properly furnished and had sufficient lighting. Linen storage observed to have adequate supply of linen and towels.

LIC 809C continued...

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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: SUNRISE AT LINDLEY I	FACILITY NUMBER: 197610293
	VISIT DATE: 03/18/2024

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LIVING ROOM: LPA's observed the living area. Adequate furnishings, sufficient lighting is maintained and was found to be clean with adequate seating for residents.

RESTROOMS: There were six (6) bathrooms designated for residents. Each bathroom has posted “wash your hands” signs and were clean, properly supplied and maintained functional fixtures.

Water temperature for each restroom was recorded at 117.0 F.

Smoke alarms and carbon monoxide detectors were present and function properly. There is one (1) fire extinguisher attached to kitchen wall was observed to charged. Extinguisher purchased on 7/11/2023. The other fire extinguisher is located at the entrance of the facility on your left-hand side.

OUTDOOR AREA: In the backyard, a patio table, umbrella and sufficient number of chairs observed with adequate seating for residents. There is no bodies of water present in the facility grounds. There is no garage to the facility.

RECORDS: LPA conducted a complete file review of four (4) staff records and six (6) resident records. Both Staff records and Resident records appear to be complete and updated.

Required posting are observed to be complete and current and displayed properly at the facility. There is no annual fee owed at this time.

There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to facility representative, Ruzanna Manukyan.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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