195850173-2-21-2024-29-AS-EPEI-D2P33M-20240221165345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:54:37 PM

Document Has Been Signed on 02/21/2024 04:54 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	A'MORECARE HOME ASSISTED LIVING		FACILITY NUMBER:	195850173
ADMINISTRATOR:	ANNETTE AMIRKHANIAN		FACILITY TYPE:	740
ADDRESS:	23511 BERDON STREET		TELEPHONE:	(818) 704-0012
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 2	DATE:	02/21/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	03:31 PM
MET WITH:	Paramjit Kaur and Jagdeep Singh, Applicants		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Emily Peraldi and Valeria Conway conducted an unannounced visit to this location for the purpose of delivering Notice of Operation in Violation of Law (NOVL) issued on 02/21/2024. At 3:31 p.m., the LPAs met with staff and explained the reason for the visit. At 3:38 p.m., LPA Peraldi spoke with current Administrator Annette Amirkhanian telephonically regarding today’s visit. At 4:16 p.m., the Applicants, Paramjit Kaur and Jagdeep Singh arrived at the facility. At 3:31 p.m., LPAs gained entry onto the property and observed two (2) residents and one (1) staff. During the time of the visit, LPA Peraldi had several conversations with the Applicant and current Administrator regarding the current state of the License. The Applicants explained that an application for a change of ownership was sent out in January 2024. The LPAs informed the Applicants that at this time, they are operating unlicensed, and a completed application needs to be submitted in order to be in compliance of section 1569.10 and/or 1569.44 of the Health & Safety Code. A Notice of Operation in Violation of Law (NOVL) was issued. The Applicant was advised that a retroactive civil penalty of $100 per day per resident shall be assessed on the 16th day from the original date of the notice of Operation in Violation of the Law (February 21, 2024) for the operation of an unlicensed facility. If the operator has not ceased operation or submitted a completed application for licensure within 15 calendar days of the issuance of this notice. On the 16th day from the notice, if the unlicensed operation continues to operate, a $200 per resident per day will be assessed until a completed application is submitted or the operation ceases. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A'MORECARE HOME ASSISTED LIVING	FACILITY NUMBER: 195850173
	VISIT DATE: 02/21/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The LPAs had a conversation with the Applicants with the goal of providing education on the transferability of a license. The LPAs explained that per Title 22, Division 6 Chapter 8, 87109 Transferability of License- (a)The license shall not be transferable. The LPAs also provided education on Health and Safety Code 1569.191 Sale of licensed facility; resulting issuance of new license; procedure. The Applicants stated that they understand that the corporation should not have been sold without the proper procedures change of ownership. The Applicants stated that they have a management agreement with the current Licensee and can send it to the LPAs. The Applicants also said that they can change the corporation back to the current Licensee while the application is processing. The Applicants stated that they are in constant contact with the current Licensee and Administrator. The Applicants stated that they are still working on the change of ownership application.

The Applicant may submit a complete application at the Woodland Hills Adult and Senior Care Regional Office located 21731 Ventura Blvd STE 250, Woodland Hills, CA 91364. The Applicant may go to www.ccld.ca.gov for orientation information. The LPAs reminded the Applicant to not take in additional residents.

Citation was issued per Health and Safety Code. See LIC 809-D included with this report.

Exit interview conducted. Appeal rights and a copy of the report was issued. NOVL issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 02/21/2024 04:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A'MORECARE HOME ASSISTED LIVING	FACILITY NUMBER: 195850173
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/22/2024 Section Cited HSC 1569.10	1 2 3 4 5 6 7	HSC: 1569.10 RCFE; license or permit; necessity: No person… corporation... shall operate…conduct, or maintain a residential facility for the elderly in this state without a current valid license or current valid ...This requirement was not met as evidenced by	1 2 3 4 5 6 7	Applicant was informed to either relocate residents (in need of care and supervision) to a licensed facility or submit a complete application within 15 calendar days of this date. LPAs advised Applicant that they have 15 calendar days (03/07/2024) to complete the plan of correction.
	8 9 10 11 12 13 14	Based on interviews and record review, the Licensee did not comply with the section cited above as the Licensee sold the corporation to Applicant without proper new license which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	If uncorrected, civil penalties will be assessed.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3