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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610839
Report Date: 12/30/2025
Date Signed: 12/30/2025 03:57:52 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/24/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251224094842
FACILITY NAME:SUNNARA GOLD INCFACILITY NUMBER:
197610839
ADMINISTRATOR:HOVHANNISYAN, HRACHFACILITY TYPE:
740
ADDRESS:14907 HUBBARD STREETTELEPHONE:
(818) 934-7783
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 5DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alexandra Vetoshkina, Staff TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Unlicensed care
INVESTIGATION FINDINGS:
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At 9:30am, Licensing Program Analyst (LPA) Angela Panushkina, along with Joycelynn Mantuano, from the Adult Protective Services, conducted an unannounced visit at the above location. Upon arrival the team was greeted by a Staff (S1), who granted access to home. S1 contacted the Operator, Irina Raskopina, and LPA explained the reason for the visit.

The Department received information that this location provides care and supervision to individuals living in the home without a license. At 09:45am, the team conducted a tour of the home and observed the following: The home has three (3) bedrooms and two (2) bathrooms. Home appeared to be clean and there was a sufficient supply of food.

Based on interviews conducted and information obtained during the visit, it was determined that five (5) out of five (5) individuals residing in the home require and were receiving elements of care and supervision.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20251224094842
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SUNNARA GOLD INC
FACILITY NUMBER: 197610839
VISIT DATE: 12/30/2025
NARRATIVE
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Elements of care and supervision include assistance with Activities of Daily Living (ADL), such as bathing, dressing, using the toilet, and arranging medical and dental services. Additionally, LPA reviewed STD850 "Fire Clearance" that was submitted on 10/15/25 and observed that on 10/22/25 the fire clearance granted for six (6) ambulatory ONLY. Therefore, the allegation of "Unlicensed Care" is Substantiated.

A Notice of Operation in Violation of Law (NOVL) was issued. The Operator was advised that a retroactive civil penalty of $100 per day per tenant shall be assessed from the original date of the NOVL (December 30th, 2025) for the operation of an unlicensed facility. If the Operator has not ceased operation within 15 calendar days of the issuance of this notice, $200 per resident per day will be assessed beginning on the 16th day until the operation ceased.

The LPA reminded the Operator not to take in individuals who are in need of care and supervision in which a license is required. The Operator informed LPA that an application for Licensure “SUNNARA GOLD INC” # 197610839 was already submitted on 06/13/2025, with Community Care Licensing Division, and the Pre-Licensing visit was conducted on 11/13/2025, however, the license is still under the pending status.

Deficiency issued on LIC9099-D.
Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251224094842
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SUNNARA GOLD INC
FACILITY NUMBER: 197610839
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2026
Section Cited
HSC
1569.10
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§1569.10 RCFE; license or permit...
No person, firm, partnership, association, or corporation within the state and no state or local public agency shall operate, establish, manage, conduct, or maintain a residential facility for the elderly in this state without a current valid license...
This requirement is not met as evidenced by:
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The Operator already submitted the application on 06/13/25. However, the application is still pending and the fire clearance was approved for six (6) ambulatory only. Operator will also submit a new LIC200 along with the facility sketch
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Based on interviews conducted, LPA and APS were informed that five (5) out of five (5) individuals are non-ambulatory and receiving elements of care and supervision, which poses an immediate health and safety risk or personal rights risk to residents in care.k or personal rights risk to residents in care.
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requesting five (5) Non-ambulatory and one (1) bedridden.
Therefore, five (5) individuals residing at this home must be relocated before POC date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3