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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610382
Report Date: 05/02/2023
Date Signed: 05/02/2023 03:12:35 PM


Document Has Been Signed on 05/02/2023 03:12 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:LIFELONG SENIOR LIVINGFACILITY NUMBER:
197610382
ADMINISTRATOR:KAPIKYAN, ANDRANIKFACILITY TYPE:
740
ADDRESS:16003 LUDLOW STREETTELEPHONE:
(747) 203-4493
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 4DATE:
05/02/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Andranik KapikyanTIME COMPLETED:
03:30 PM
NARRATIVE
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An informal meeting was held today at the Woodland Hills Regional Office to discuss the applicant's non-compliance during their application process. Present at today’s meeting were: Andranik Kapikyan, Applicant/Administrator; Regional Manager (RM) Angela Kendrick, Licensing Program Managers (LPMs), Eva Miller and Troy Agard and Licensing Program Analysts (LPAs) Melissa Ruiz, Angela Panushkina, and Michael Cava.

The informal conference process was explained to the Applicant. The applicant was also informed that this Informal Conference is part of the administrative action process and that further non-compliance and/or citations would result in requiring the attendance at a Non-Compliance Conference meeting.
During today’s conference, the following matters were discussed:

- On April 21, 2023, the Department received an Unlicensed Complaint allegation. It was also alleged that a resident physically attacked another resident, causing Resident 1 (R1) injuries, resulting in hospitalization. The Unlicensed allegation was Substantiated and a Notice of Violation of Law (NOVL) were issued on April 25, 2023. At the time of the visit, facility had a census of six (6).

Applicant currently has four (4) residents. The applicant is in the process of relocating the remaining residents. They were advised that the application process is suspended pending consultation with the Department's Legal Division. The applicant stated that he understands that he cannot continue operation, and agreed to provide LPA Cava with an update on all resident relocation, including the location where all residents were moved to. Exit interview conducted and a copy of this report issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
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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