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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 10/16/2022
Date Signed: 10/16/2022 10:35:39 AM


Document Has Been Signed on 10/16/2022 10:35 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. #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: 4DATE:
10/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tsiana (Anna) MikiaTIME COMPLETED:
10:15 AM
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Licensing Program Analysts (LPAs), Martha Arroyo and Brian Balisi conducted an unannounced Case Management-Other visit at this facility. Upon arrival, LPA's were greeted at the door by staff, Tsiana (Anna) Mikia and was explained the reason for the visit. Entrance interview.

At 8:30 a.m., the LPA’s toured the facility with the staff to ensure there are no health and safety concerns. The LPA’s interviewed one staff at 9:05 a.m. and interviewed two residents between 8:40 a.m and 9:00 a.m. LPA’s also conducted a resident file review at 9:20 a.m.

Exit interview conducted. No citations issued. A copy of the report was provided via email.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2022
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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