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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 04/11/2024
Date Signed: 04/11/2024 11:38:30 AM


Document Has Been Signed on 04/11/2024 11:38 AM - 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: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: 4DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Paramjit KaurTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Zabel Chochian and Sandra Urena conducted an unannounced visit to this location along with Long Term Care Ombudsman (LTCO) Ginger Perini for the purpose of notifying applicant Paramjit Kaur, that the licensure application for this property has been denied by Community Care Licensing’s (CCL) Centralized Applications Bureau, effective April 11, 2024.

At approximately 9:25a.m., LPAs gained entry onto the property and observed four (4) individuals residing at the facility that require care and supervision. LPAs and LTCO toured the property with staff to ensure there were no health and safety concerns.

At approximately 9:44am., the LPAs spoke with Applicant, Paramjit Kaur over the telephone. Reason for the visit was explained. Ms. Kaur acknowledged receiving the Department’s application denial letter that was sent via email and certified mail on 4/11/2024. Ms. Kaur arrived to the facility and met with LPAs and LTCO. Ms. Kaur was informed that a second Notice of Operation in Violation of Law (NOVL) will be served during today’s visit. An initial NOVL was served to Paramjit Kaur and Jagdeep Singh on 2/21/2024. During today’s visit, LPAs provided a copy of the Department’s application denial letter for this property. Per the NOVL, Ms. Kaur must relocate all individuals requiring care and supervision by April 26, 2024. It was also explained to Ms. Kaur that per Health and Safety Code 1569.16(b), re-submitting an application will not correct today’s citation, as an applicant does not have the right to re-apply for licensure for one year after the Department’s application denial. Therefore individuals in the home requiring care and supervision shall be relocated.

Citation was issued per Health and Safety Code.
Exit interview conducted and a copy of this report was provided to Ms. Kaur.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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 2


Document Has Been Signed on 04/11/2024 11:38 AM - 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
CCLD Regional Office, 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: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/26/2024
Section Cited
HSC
1569.10

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HSC: 1569.10. RCFE; license or permit; necessity: No person,... or corporation... shall operate,…manage,…or maintain a residential facility for the elderly in this state without a current valid license ...This requirement was not met as evidenced by:
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The Applicant agreed and acknowledged that she shall relocate all individuals requiring care and supervision by April 26, 2024. The Applicant also agreed to provide proof of each individuals relocation site. Re-submitting an application will not correct today’s citation, as an applicant does not have
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Based on interviews and record review, the Applicant did not comply with the section cited above as four (4) out of four (4) individuals require assistance with aspects of care in activities of daily living, which poses an immediate health and safety risk to individuals in care.
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the right to re-apply for licensure for one year after the Department’s application denial.

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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2