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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 12/14/2022
Date Signed: 12/14/2022 04:52:32 PM


Document Has Been Signed on 12/14/2022 04:52 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:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Oganes Duymalyan, Akhtar RoshanaeianTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Emily Peraldi and Zabel Chochian, arrived unannounced to conduct a Case Management – Other visit at this facility. At 3:20 p.m., the LPAs met with staff and explained the reason for the visit. At 3:44 p.m., the Licensee, Oganes Duymalyan arrived at the facility.

At 3:55 p.m., the LPAs spoke with the Licensee regarding the recent staffing shortage. At 3:43 p.m., applicant, Akhtar Roshanaeian arrived at the facility. The LPAs reminded the Licensee and the applicant that staff that are not fingerprinted or are not associated to the facility cannot be working at the facility. LPA Peraldi also requested an updated LIC 500 to ensure that there will be sufficient staffing. The Licensee and the applicant agreed on working together to ensure that staffing will be sufficient. The Licensee and the applicant stated that the facility will ensure that all staff will have a criminal record clearance and are associated to the facility prior to working at the facility. No immediate health and safety concerns were observed during today's inspection.

Exit interview conducted. Report will be provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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