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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 08/04/2020
Date Signed: 08/04/2020 10:19:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:MNOYAN, MAYA S.FACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:113CENSUS: 70DATE:
08/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Maya Mnoyan TIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jennifer Lott conducted a Case Management visit to deliver an amended report for a visit conducted on 07/28/2020. LPA Lott met with Administrator, Maya Mnoyan via Tele-Visit due to Covid-19 and informed them of the purpose of her visit.

During today’s visit, LPA delivered the amended report dated 07/28/20 via email.

An exit interview was conducted and a copy of this report along with the Licensee’s Rights (LIC 9058 01/16) was provided to Administrator, Mnoyan via email. An email read receipt confirms receipt of these documents.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020
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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