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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:45:39 PM


Document Has Been Signed on 10/14/2022 03:45 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:SANDY KHAMBEKYANFACILITY TYPE:
740
ADDRESS:13303 REEDLEY STREETTELEPHONE:
(747) 264-0032
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 5DATE:
10/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Oganes Duymalyan, LicenseeTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a case management - incident visit for the purpose of addressing an incident LPA was made aware of while conducting an unrelated visit at the facility today. LPA met with Licensee Oganes Duymalyan. Entrance interview conducted.

LPA was made aware of an alleged incident which occurred on 10/13/2022 involving Resident #1 (R1)'s personal rights. At the time of this report, LPA had not received a written report of this incident.

LPA will return at a later date to continue investigation into this incident.

Exit interview was conducted with Licensee Oganes Duymalyan. A copy of the report was provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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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