197610532-2-3-2024-31-AS-NMAN-D3BV27-20240313160240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610532
Report Date: 02/03/2024
Date Signed: 02/03/2024 12:39:39 PM

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
10/24/2023 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20231024152959

FACILITY NAME:	GOLDEN BLISS BOARD AND CARE		FACILITY NUMBER:	197610532
ADMINISTRATOR:	TERZYAN, NVART		FACILITY TYPE:	740
ADDRESS:	8609 AQUEDUCT AVE		TELEPHONE:	(818) 697-3926
CITY:	NORTH HILLS	STATE:	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 6	DATE:	02/03/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Marianna Ghazaryan		TIME COMPLETED:	12:42 PM

ALLEGATION(S):

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Unlicensed Care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tihesha Smith made an unannounced subsequent complaint visit to this location at approximately 10:10 am. LPA was greeted by staff who informed Marianna was on the way. Marianna arrived shortly and LPA disclosed the purpose of the visit.

On 11/02/2023, a Notice of Operation in Violation of Law (NOVL) and citation under Health and Safety Code 1569.44 was issued. During the initial visit Tenant #1 (T1) was determined to have needed care and supervision. Prior to this visit operator notified LPA Smith that T1 was relocated to a licensed facility on 11/04/2023.

During today’s visit, LPA conducted a brief tour of the facility and confirmed that T1 is no longer living at the facility and T1’s bed is cleared. LPA observed the facility to be clean and has a sufficient supply of food.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2024

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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Control Number 31-AS-20231024152959

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GOLDEN BLISS BOARD AND CARE	FACILITY NUMBER: 197610532
	VISIT DATE: 02/03/2024

NARRATIVE

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(Cont from 9099)

LPA Smith’s interview with the operator revealed that there was no untoward incident at the facility since LPA’s last visit and there are no tenants in the home that require care and supervision.

The operator has submitted an application at the Woodland Hills Adult and Senior Care Regional Office located 21731 Ventura Blvd STE 250, Woodland Hills, 91364 for licensure within 15 calendar days of the issuance of the Notice of Operation in Violation of Law (NOVL).

Operator was also reminded to not accept any client that requires any element of care and supervision until the facility is licensed.

No health and safety issues observed during this visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2024

LIC9099 (FAS) - (06/04)

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