197610382-12-6-2023-31-AS-MVAO-CYPNL9-20231220093308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610382
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:26:20 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230421132240

FACILITY NAME:	LIFELONG SENIOR LIVING		FACILITY NUMBER:	197610382
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	16003 LUDLOW STREET		TELEPHONE:	(747) 203-4493
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	0	CENSUS: 0	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Adranik Kapikyan		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Unlicensed care

INVESTIGATION FINDINGS:

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In conjunction with a pre-licesing visit (see pending application under facility #197619483) Licensing Program Analysts (LPAs) Nicholas Reed and Michael Cava conducted a subsequent complaint visit to conclude the investigation regarding Unlicensed Care. On 04/25/23, LPAs Gary Tan and Cava conducted the ten day visit to the home. During that visit, it was deemed the home had two (2) out of six (6) individuals requiring care ad supervision. Based on this observation, the allegation of Unlicensed Care was Substantiated. The purpose of this visit was to insure the two residents, that were identified to require care and supervision, have moved. Per pre-licensing inspection, the home was empty. There were zero (0) residents at the time of the visit.

Per observation of today's inspection, the Unlicensed Care has ceased operation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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