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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603526
Report Date: 12/27/2022
Date Signed: 12/27/2022 03:11:14 PM


Document Has Been Signed on 12/27/2022 03:11 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:SUNNY GARDEN SENIOR CARE LLCFACILITY NUMBER:
198603526
ADMINISTRATOR:BARSEGHYAN, ARAMFACILITY TYPE:
740
ADDRESS:1019 RALEIGH STTELEPHONE:
(747) 270-7638
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:6CENSUS: 0DATE:
12/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee - Aram BarseghyanTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Ashley Calderon made an unannounced visit for a required inspection. Upon arrival LPA met with Licensee/ Administrator: Aram Barseghyan.

LPA Calderon toured the facility along with Aram and the following was observed: Facility contains 5 bedrooms and 3 bathrooms in the main building , dining room, living room, kitchen, detached garage, laundry area and backyard with an additional restroom. Facility has a census of zero (0) residents.

LPA observed the kitchen area, there was sufficient supply of 2 day perishables and 7 day non perishables. LPA took measurement of the hot water, temperature read at 120 Fahrenheit. Sharp items and chemicals were locked. No medication for residents stored at this time, cabinet remain locked and inaccessible. LPA observed resident bedrooms, which have appropriate bedding and furniture like chair, night stand, sufficient lighting and a chest of drawers / closet space. LPA observed storage areas to have extra towels and linens. Backyard was observed to have a shaded area and garage remains locked and inaccessible to residents.

LPA went over the Inspection Control Domain for Covid-19 measurements and preparedness, LPA provided Technical Assistance for Covid-19. LPA went over Guardian, LPA reviewed PowerPoint component three as a refresher as Licensee is working through an agency to get residents.

Per California Code of Regulations, Title 22, and California Health and Safety Code, No deficiency were observed during the visit.

An exit interview held and a copy of the report were provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley CalderonTELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2022
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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