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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 02/13/2023
Date Signed: 02/13/2023 03:44:35 PM


Document Has Been Signed on 02/13/2023 03:44 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: 2DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hripsime 'Ripa' Tavitian and Akhtar RoshanaeianTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Emily Peraldi and Ashley Smith conducted a required annual visit. The LPAs met with staff and explained the reason for the visit. The LPAs and staff toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Knives and chemicals were locked inaccessible. In observing the stove, it was noted that one (1) out of four (4) burners was inoperable; yet the licensee noted that they have asked the owner to replace the stove. The facility has a sufficient supply of perishable and non-perishable food. At 10:50 a.m., the LPA observed the following non-perishable items that were expired: rice, pasta, grits, au gratin potatoes. Items were disposed of upon observation; technical violation issued at this time. BEDROOMS: Bedrooms had appropriate furnishings, clean linens and sufficient lighting. RESTROOMS: Resident restrooms were fully stocked, and were clean and sanitary with grab bars and non-skid surfaces. Hand-washing signs were observed in the restrooms. At 10:35 a.m., water temperature measured at 116.6 degrees F. COMMON SPACES: Smoke detectors and carbon monoxide detectors were operable at the time of the visit. The facility maintained a temperature of 75 degrees. Living room and dining furniture were observed in good condition. Exits have functioning auditory devices. Fire extinguishers were charged and purchased within the past twelve (12) months. Postings were observed at the front entrance. The backyard had furniture and a covered area for resident use. There is an in-ground pool in the backyard, which was gated and locked.

Infection Control: There is a central entry point for signing in, universal screening and temperature checks. Staff were observed wearing appropriate face masks. There was an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol was sufficient. The facility can designate a single-person room to isolate persons if there is a confirmed case of COVID-19. Provider Information Notices (PINs) and Emergency Plan was observed at the entrance. Staff are up to date regarding guidelines around visitation, best practices regarding screening visitors and staff, and vaccine requirements.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023
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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