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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801682
Report Date: 01/24/2025
Date Signed: 01/24/2025 05:50:07 PM

Document Has Been Signed on 01/24/2025 05:50 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNSHINE HEALTH PLACEFACILITY NUMBER:
565801682
ADMINISTRATOR/
DIRECTOR:		SLIM MARONFACILITY TYPE:
740
ADDRESS:1558 NORMAN AVENUETELEPHONE:
(805) 446-3100
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Cilva Toume and Vana Barberis - Assistant Administrator TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility for a required annual inspection. Upon arrival, the LPA was greeted at the door by staff. Administrator Cilva Toume was contacted by staff and arrived shortly thereafter.

At approximately 3p.m, the LPA and staff began the physical plant tour (inside and outside) to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: The LPA observed common area to be clean and properly furnished at the time of the visit. The LPA observed the fire extinguisher to be fully charged and last purchased on 07/2024. Smoke and carbon monoxide detectors were tested and functioned properly. The temperature was maintained at a comfortable level of 74 degrees F. Cleaning supplies and disinfectants are stored inaccessible under the kitchen sink cabinet, in the garage. KITCHEN: Kitchen/dining area observed. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. Supply of perishable food items good for two days and non-perishable food items for seven days observed at the facility during todays visit. RESTROOMS: Observed restrooms to be clean and sanitary and in operating condition with grab bars and non-skid surfaces during todays visit. Hot water measured at 118 degrees Fahrenheit in resident restrooms. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #6 (near the living) is cleared for ambulatory resident only. LPA observed this room occupied by a non-ambulatory resident. Although there is direct access to the outside from this room it is not fire cleared for non-ambulatory at this time.

Due to time constraints, the LPA will return at a later date to complete the inspection.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Immediate civil penalty issued. Exit interview conducted. Copy of the report and appeal rights provided.
Desaree PereraTELEPHONE: (818) 596-4347
Zabel ChochianTELEPHONE: (818) 419-5440
DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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Document Has Been Signed on 01/24/2025 05:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: SUNSHINE HEALTH PLACE
FACILITY NUMBER: 565801682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
87202(a)(1)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (1) Nonambulatory persons.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above: Non ambulatory resident residing in room fire cleared for only ambulatory. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2025
Plan of Correction
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Licensee agreed to move resident immediately until proper fire clearance is obtained for room 6 (six). Submit written plan of correction and photos of room unoccupied by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Desaree PereraTELEPHONE: (818) 596-4347
Zabel ChochianTELEPHONE: (818) 419-5440

DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2025

LIC809 (FAS) - (06/04)
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