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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:00:20 PM


Document Has Been Signed on 04/18/2024 04:00 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:
04/18/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Paramjit Kaur TIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi arrived unannounced to conduct a Collateral visit. At 9:30 a.m., the LPA met with staff and explained the reason for the visit. The purpose of the visit is in regard to an investigation of a complaint which is unrelated to this facility.

During the time of the visit, at 9:48 a.m., LPA Peraldi conducted an interview with Staff #1 (S1).

No health and safety concerns were observed during this visit. Exit interview conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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