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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005434
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:12:22 AM


Document Has Been Signed on 05/24/2023 10:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:SENIOR ASSISTED CARE HOMESFACILITY NUMBER:
306005434
ADMINISTRATOR:MARK STRAUSSFACILITY TYPE:
740
ADDRESS:15311 CASCADE LANETELEPHONE:
(562) 394-5940
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 0DATE:
05/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Karen MahmaljiTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted a case management visit for the purpose to verify the facility closure. LPA arrived at facility was greeted and granted entry by Karen Mahmalji, Administrator.

The Department was informed on May 17, 2023 by Mark Straus, Administrator that the facility had no residents and home has been sold. Administrator indicated that as of June 15, 2023 they will no longer have access to the facility. The licensee no longer was operating as a licensed facility. Administrator informed LPA Martinez that last resident moved out July of 2022. Last facility visit conducted on February 10, 2023 by LPA Tirre report indicated facility had no residents. Mark Straus, Administrator informed LPA Tirre that license would be mailed back to the department

LPA accompanied by Administrator toured the one-story home facility and observed no resident in care. LPA observed that the home had several moving boxes in the living room, an escrow sign in the main entrance of the facility and resident bedrooms were empty with no furnishing or minimum furnishing in them. LPA observed the home to be empty of residents and found no evidence the home is operating as a licensed facility. The only occupant of the facility at the time is Karen Mahmalji, Administrator. Based on observations, the facility is no longer operating as a licensed facility and is closed.

This report was reviewed with Administrator and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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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