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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850126
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:48:36 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:
(747) 264-0032
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 4DATE:
11/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Tsisana Mikia, Caregiver TIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived to this location today for the purpose of conducting a Case Management- Other follow-up inspection visit. At 2:39 p.m. LPA met with caregiver Tsisana “Anna” Mikia and explained reason for visit. Staff contacted operator Akhtar "Ellie" Roshanaeian and the reason for the visit was discussed. Ellie was unavailable to meet with the LPA and authorized Anna to sign the report.

A Notice of Operating in Violation of Law (NOV) was issued to Akhtar "Ellie" Roshanaeian during a visit on 10/25/2021.Interviews were conducted and information obtained revealed that three (3) out of the three (3) residents living at the home require, and is being provided, care and supervision by the operator/staff. This location was previously licensed as Golden Century Assisted Living, Inc. on 03/08/2021, despite Ms. Roshanaeian explaining that she bought the facility license from the previous licensee on 01/04/2021. However, on 09/09/2021, the licensed corporation underwent a 100% change in ownership reflecting Ms. Roshanaeian as the only managing member, effectively replacing Oganes Duymalyan. On 10/26/2021, the corporation underwent another 100% change of ownership back to Oganes Duymalyan. At this time, Ms. Roshanaeian has control of property. If a licensee loses control of property, the licensee is no longer licensed by the Department.
At 2:40 p.m. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards. At 2:41 p.m. LPA observed a fourth (4) resident that requires care and supervision. Interviews with staff revealed that the fourth (4) resident moved in on 11/02/2021.

A discussion was held with Ellie regarding the submission of plan of corrections (POCs) from visits on 10/25/2021. On 10/25/2021, the facility was cited for not having an updated appraisal for Resident #1 (R1). The Proof of Correction was due on 11/01/2021. As of today, the plan of correction has not met; civil penalty issued for failure to correct. Civil penalties will be issued for period 11/02/2021 -11/03/2021 which is two (2) days and will result in $100.00 per day. Civil Penalties will accrue until plan of correction is met.
Exit interview conducted. A copy of the report was issued. Civil penalties and related appeal rights issued.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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