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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005559
Report Date: 03/29/2022
Date Signed: 03/30/2022 07:36:43 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/30/2022 07:36 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:SUNNYVALE SENIOR LIVINGFACILITY NUMBER:
306005559
ADMINISTRATOR:SHINMAR, MUINDEEP CFACILITY TYPE:
740
ADDRESS:2116 W CRONE AVETELEPHONE:
(714) 603-4095
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:10CENSUS: 0DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Muindeep C. ShinmarTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez arrived to facility, rang door bell and knocked several times. LPA Martinez could hear people speaking but no one answered the door. After about 5 minutes, LPA called facility number (714) 603-4095 and person who answered stated LPA had the wrong number and hung up. LPA called mobile number on file (714) 408-0914...Mundeep Shinmar answered line...LPA introduced herself and stated she was at facility attempting to do Required 1 year visit. Mundeep stated he closed facility down because he could not get residents during due to COVID. He said he reported this to the Ombudsman since he did not have an assigned LPA. LPA asked Mundeep if he had control of the property and he stated it was a lease and has no clue who lives at the home currently.

LPA requested Mundeep to please send LPA an email with who he spoke and history of events. Also to please forward license to LPA. Muindeep agreed.

LPA left facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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