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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:15:04 PM


Document Has Been Signed on 03/07/2024 03:15 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 LIVINGFACILITY NUMBER:
195850173
ADMINISTRATOR:ANNETTE AMIRKHANIANFACILITY TYPE:
740
ADDRESS:23511 BERDON STREETTELEPHONE:
(818) 704-0012
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 3DATE:
03/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Evangeline Zinampan, staffTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced case management visit at the above location. At 2:30 p.m., the LPA met with staff and explained the reason for the visit. At 2:40 p.m., the LPA spoke with Applicant Paramjit Kaur over the telephone. The Applicant was not available to meet the LPA and authorized staff, Evangeline Zinampan to sign the report.

On 02/21/2024, a Notice of Operation in Violation of Law (NOVL) was issued. The Applicants explained that an application for a change of ownership was sent out in January 2024.

The purpose of the visit is to ensure there are no health and safety hazards. At 2:48 p.m., the LPA reviewed resident records. At 3:00 p.m., the LPA along with staff toured the facility. The LPA observed three (3) residents at this location. The Applicant stated that one (1) more resident is going to be admitted to the facility today, 03/07/2024. The Applicant stated that they are working with the current Administrator. The LPA reminded the Applicant to not take in additional residents.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
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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