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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221435
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:32:57 PM

Document Has Been Signed on 03/05/2025 02:32 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BROOKDALE CHATSWORTHFACILITY NUMBER:
191221435
ADMINISTRATOR/
DIRECTOR:
AMANDA MONROYFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE BLVDTELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 268TOTAL ENROLLED CHILDREN: 0CENSUS: 115DATE:
03/05/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Anchirriza Concepcion, Health and Wellness DirectorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At 1:00pm, Licensing Program Analyst (LPA), Angela Panushkina, Fire Inspector, Linsay Pellegrini along with the Building Mechanical Inspector, Ara Sinanian conducted a Case Management visit. The team met with the Health and Wellness Director, Anchirriza Concepcion, and explained the reason for the visit.

LPA requested resident and staff roster. The facility currently has approximately twenty (20) non-ambulatory residents residing on a second floor. During the 10/10/24 and 12/17/24 visits, LPA informed the facility that this is a Health and Safety issue and requested to provide a Written Plan within 48-hours. However, during today's visit, a third request was made for the facility to submit a written plan. The team was informed that the facility continues to conduct routine checks on non-ambulatory residents every two (2) to four (4) hours.


At 1:50pm, Executive Director contacted the LPA and the team conducted an interview over the phone. The Building Mechanical Inspector confirmed during the interview that the facility is operation outside their certificate of occupancy. The team was informed that the facility currently has twenty (20) non-ambulatory residents still residing on a second floor and Brookdale’s District is currently working on an issuance of a letter that will be send to residents/families regarding the relocation. The team was informed that by the end of March 2025 all non-ambulatory residents from the second floor will be relocated/moved.

No deficiency issued during today’s visit.
Exit interview conducted and copy of this report signed and delivered.
Nichelle GillyardTELEPHONE: (818) 596-4341
Angela PanushkinaTELEPHONE: 747-230-3364
DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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