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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604092
Report Date: 10/18/2023
Date Signed: 10/18/2023 03:43:47 PM


Document Has Been Signed on 10/18/2023 03:43 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:SENIOR LIVING NORWOODS HACIENDAFACILITY NUMBER:
374604092
ADMINISTRATOR:PETROSYAN, ANNAFACILITY TYPE:
740
ADDRESS:35 EL RANCHO VISTATELEPHONE:
(818) 284-2502
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 0DATE:
10/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Jonathan TorresTIME COMPLETED:
10:13 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced case management visit regarding the facility being closed. LPA called Licensee Linet Manasyan via telephone and Licensee stated she would send manager Jonathan Torres to the facility to meet LPA. Manager Jonathan Torres arrived at the facility and LPA discussed the purpose of the visit.

Manager Jonathan Torres advised LPA that the facility was closed on approximately January 5, 2023 and he did not have access to enter the facility. LPA Serrano walked along the outside of the facility property and observed that the facility was completely vacant with no signs of any persons living inside of the facility. It should also be noted that their was a "For Sale" sign on the property.

Manager Jonathan Torres advised LPA that all of the residents were moved to "sister" facilities with the exception of one resident who moved in with their family. LPA was provided with a list of the residents that lived at the facility prior to the closure which included the resident's name and their new address.

An exit interview was conducted with Jonathan Torres. A copy of this report along with Licensee Rights was provided to Jonathan Torres whose signature below verifies receipt of these rights.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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