195850173-4-18-2024-29-AS-EPEI-D4FUZF-20240418160127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:02:18 PM

Document Has Been Signed on 04/18/2024 04:02 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: 3	DATE:	04/18/2024
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Paramjit Kaur		TIME COMPLETED:	04:10 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 Analyst (LPA) Emily Peraldi conducted an unannounced visit to this location along with Long Term Care Ombudsman (LTCO) Ginger Perini to ensure there are no health and safety concerns. At 9:30 a.m., LPA Peraldi and Ombudsman Perini were allowed entry by staff and explained the reason for the visit. At 9:54 a.m., LPA Peraldi and Ombudsman Perini spoke with Applicant, Paramjit Kaur over the telephone. At 3:24 p.m., Applicants, Paramjit Kaur and Jagdeep Singh arrived at the facility. On 04/11/2024, LPAs Zabel Chochian and Sandra Urena delivered a denial letter and notified Applicant Paramjit Kaur and Jagdeep Singh, that the licensure application for this property has been denied by Community Care Licensing’s (CCL) Centralized Applications Bureau, effective April 11, 2024. On 04/11/2024, Applicant, Ms. Kaur was served a second Notice of Operation in Violation of Law (NOVL). An initial NOVL was served to Paramjit Kaur and Jagdeep Singh on 2/21/2024. 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. At 9:38 a.m., LPA Peraldi and Ombudsman Perini along with staff toured the facility. LPA Peraldi observed three (3) residents at this location who require care and supervision. Perishable and non-perishable foods were observed and were sufficient. Between 9:32 a.m. and 11:18 a.m., LPA Peraldi spoke with two (2) residents, and one resident’s family member. At 3:03 p.m., LPA Peraldi, and Licensing Program Manager (LPM) Kristin Heffernan had a joint telephone conversation with applicant Paramjit Kaur and current Administrator Annette Amirkhanian. During the telephone call the following was discussed: The purpose of the phone call was to discuss the plan in place for relocation of the residents. 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: 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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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: 04/18/2024

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During the conversation, both Kaur and Amirkhanian stated that they are working together to ensure the safe relocation of three (3) residents to proper licensed facilities. Both Kaur and Amirkhanian also stated that they both are in communication with all families and are assisting families with relocation efforts. LPM Heffernan emphasized the importance of accountability, health and safety of the residents in care, and proper placement. Kaur and Amirkhanian confirmed that they will send updates to LPA Peraldi of the relocation information for the residents.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 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

LIC809 (FAS) - (06/04)

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