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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:41:25 PM

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:AKHTAR ROSHANAEIANFACILITY TYPE:
740
ADDRESS:13303 REEDLEY STREETTELEPHONE:
(818) 416-0506
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 3DATE:
08/04/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tsisana Mikia and Akhtar RoshanaeianTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Ashley Smith and Emily Peraldi arrived unannounced for a Collateral visit. The LPAs met with staff Tsisana "Ana" Mikia and explained the reason for the visit. Akhtar "Ellie" Roshanaeian arrived at approximately 1:30 p.m.

Today's inspection is in regards to the investigation of complaint control #29-AS-20210202140632, which is unrelated to this facility. The LPAs conducted a physical plant tour at 10:07 a.m., interviewed staff at 10:37 a.m., and 1:50 p.m., and interviewed residents at 11:33 a.m. and 11:38 a.m.

No health and safety concerns were observed during this visit. Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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