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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222267
Report Date: 07/26/2022
Date Signed: 07/26/2022 10:11:17 AM


Document Has Been Signed on 07/26/2022 10:11 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:GOLDEN YEARSFACILITY NUMBER:
191222267
ADMINISTRATOR:MUDER, EVANGELIAFACILITY TYPE:
740
ADDRESS:15822 MAYALL ST.TELEPHONE:
(818) 892-4467
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 0DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Evangelia MuderTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Yelena Avetisyan conducted a Case Management visit to confirm closure of this facility.

Upon arrival LPA knocked on the door several minutes without a response. LPA contacted licensee/administrator Evangelia Muder via telephone. Ms. Muder informed the LPA she will come to the facility shortly. Licensee/administrator arrived approximately 9:45 am.

On 7/15/2022 LPA Avetisyan called the licensee regarding the unpaid annual fees for approximately 1.5 years. During the call Ms. Muder informed the LPA that she is unsure if she will continue to retain her license. Per licensee she hasn't had any residents for sometime.

On 7/18/2022 Ms. Muder called the LPA and informed her that due to not operating for sometime, and her current health condition she has decided to close the facility.

During today's visit, the LPA conducted a physical plant tour with Ms. Muder and confirmed that there are no resident currently living in the facility.



Per Ms. Muder she has mailed a closure notice to the Department. LPA was provided the original license. LPA informed the licensee that all copies of the license need to be destroyed as well.

Ms. Muder was informed that her license to operate a residential care facility for the elderly is closed effective today. If the current Licensee wants to open a new facility in the future, Licensee will need to submit a new application with appropriate application fees at that time. LPA will send a facility closure letter upon receipt of the closure notice.

Exit interview conducted and copy of this report emailed to the Administrator.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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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