565801625-3-5-2026-29-AS-EPEI-DRW3FX-20260305171328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801625
Report Date: 03/05/2026
Date Signed: 03/05/2026 05:14:11 PM

Document Has Been Signed on 03/05/2026 05:14 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNRISE MANOR, LLC		FACILITY NUMBER:	565801625
ADMINISTRATOR/ DIRECTOR:	JULIANA ANOS		FACILITY TYPE:	735
ADDRESS:	441 WEST CHANNEL ISLAND BLVD		TELEPHONE:	(805) 240-7600
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 60		CENSUS: 45	DATE:	03/05/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:58 AM
MET WITH:	Stacey Medina, Administrator Cathalina Anos-Hipolito, Administrator Assistant		TIME VISIT/ INSPECTION COMPLETED:	05:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 11:00 a.m., the LPA met with Administrator, Stacey Medina and explained the reason for the visit. Between 11:18 a.m. and 1:22 p.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards. During the time of the visit, the Administrator explained that the renovations have halted until August 2026. There are two (2) apartments that are unavailable due to the construction being on hold. The LPA observed all common areas to be relatively clean. Multiple fire extinguishers observed were fully charged and last serviced 09/29/2025. Medications were locked and centrally stored in the medication room. The day room/ TV room had an inoperable smoke alarm. RESIDENT APARTMENTS: The LPA conducted a tour of all resident apartments on the first and second floor. Each apartment has two (2) bedrooms, a common living area, a bathroom and storage area. Smoke alarms and carbon monoxide detectors were tested in each apartment. Apartment #2A, 3A, 4A, 4 hallway and 12B were missing smoke alarms or inoperable smoke alarms. Bathrooms in each apartment had a supply of hand soap and paper towels. Water temperature was tested in all of the resident apartments and measured within the required range between 107.8 and 112.5 degree F. KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. Knives are stored in the kitchen area and inaccessible to clients. The facility has a supply of emergency food and water. Due to time constraints, the LPA will return at a later date to complete the annual. Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted with Administrator Assistant Cathalina Anos-Hipolito. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Emily Peraldi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 03/05/2026 05:14 PM - It Cannot Be Edited

Created By: Emily Peraldi On 03/05/2026 at 04:21 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE MANOR, LLC	FACILITY NUMBER: 565801625
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80020(a)

Fire Clearance

(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee failed to comply in the section cited above as apartment #2A, 3A, 4A, 4 hallway and 12B were missing smoke detectors or had inoperable detectors which poses an immediate safety risk to residents in care.
	POC Due Date: 03/06/2026
	Plan of Correction
1 2 3 4	Within 24 hours, the Administrator will notify the LPA of the plan to ensure that all smoke and carbon monoxide detectors will be maintained in compliance. This is an immediate violation and a civil penalty of $500 being assessed

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:

	Emily Peraldi
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC809 (FAS) - (06/04)

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