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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 07/14/2022
Date Signed: 07/14/2022 03:22:49 PM


Document Has Been Signed on 07/14/2022 03:22 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:GOLDEN CENTURY ASSISTED LIVING INCFACILITY NUMBER:
195850126
ADMINISTRATOR:KATHLEEN LEITERMANFACILITY TYPE:
740
ADDRESS:13303 REEDLEY STREETTELEPHONE:
(747) 264-0032
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 5DATE:
07/14/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Tsisana “Ana” MikiaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived unannounced for a Collateral visit at this facility. At 12:11 p.m., the LPA was greeted and screened by staff. At 12:56 p.m., the LPA spoke with the Licensee, Oganes Duymalyan and explained the reason for the visit. The Licensee was not available during today’s visit and authorized staff, Tsisana “Ana” Mikia to sign the report.

Today's inspection is in regard to the investigations of complaint control 31-AS-20200421122355, 29-AS-20200430164020, and 29-AS-20200811100140 which are unrelated to this facility.

Exit interview conducted and report reviewed with staff. A copy of the report will be issued via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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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