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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005559
Report Date: 03/22/2022
Date Signed: 04/05/2022 10:41:45 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/05/2022 10:41 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:
03/22/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Muindeep C Shinmar (via telephone)TIME COMPLETED:
12:20 PM
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On today's date, Licensing Program Analyst (LPA) Sean Haddad conducted an attempted Required 1 Year Annual Inspection visit. Upon arriving to the facility, LPA observed no activity outside of the facility and the facility appeared vacant.

On or about 11:47AM, LPA knocked on the door and asked the woman who answered the door if this was SUNNYVALE SENIOR LIVING. The woman said it this was not SUNNYVALE SENIOR LIVING. LPA could see past the woman through the door and the facility appeared vacant. The woman stated she did not speak English, backed away from the door, and immediately closed it without allowing further discussion.

LPA called the facility phone number (714) 603-4095. The man who answered said this number did not belong to SUNNYVALE SENIOR LIVING and then hung up immediately. LPA called the facility mobile number and spoke to Administrator (AD) Muindeep C Shinmar via telephone. AD stated the facility had been closed for over a year and provided LPA with additional information.

Facility closure paperwork will be processed.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022
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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