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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801690
Report Date: 04/04/2024
Date Signed: 04/16/2024 03:28:54 PM


Document Has Been Signed on 04/16/2024 03:28 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SENIORS WAY INC.FACILITY NUMBER:
565801690
ADMINISTRATOR:MARGIERY D MENORCAFACILITY TYPE:
740
ADDRESS:4005 SNOWGOOSE STREETTELEPHONE:
(805) 422-8144
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:5CENSUS: 2DATE:
04/04/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Margiery Menorca & John MenorcaTIME COMPLETED:
02:14 PM
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Regional Manager (RM), Jill Nakata, and Licensing Program Analyst (LPA) Zabel Chochian met with the facility representative, Margiery Menorca, and her son, John Menorca, on this day for an office meeting to discuss the status of the license/corporation. Licensing Program Manager (LPM), Desaree Perera also was in attendance by telephone.

On 3/25/2024, During the facility annual visit, LPA Chochian observed excluded individual, Mr. Jason Menorca present at the facility. During the visit, LPA Chochian and LPM Perera discussed with administrator Margiery Menorca that the excluded individual is not allowed to be present at the facility. Licensee was cited and civil penalties were issued.


The Decision and Order (D&O) dated 6/9/2019, was reviewed with Margiery Menorca during a Case Management visit on 8/28/2019. The Decision of the Department of Social Services denying a criminal record exemption for Jason Menorca was affirmed. It was so ordered on July 12, 2019, and adopted/effective July 22, 2019. Therefore, Jason Menorca is hereby prohibited from being a licensee, owning a beneficial ownership of 10 percent or more in a licensed facility, or being an administrator, officer, director, member, or manager of a licensee or entity controlling a licensee, and, further, from employment in, presence in, and from contact with clients of, any facility licensed by the Department until a criminal record exemption is obtained. During today’s visit, RM Nakata again discussed the D&O issued to Mr. Jason Menorca. RM inquired what Mrs. Menorca was intending to do with 50% of corporation belonging to Mr. Menorca as he is not allowed to have any ownership in a licensed facility. Mrs. Menorca and Mr. John Menorca stated that they will review the options discussed today and make a decision within a week from today (04/11/204) to either submit a change in corporate structure application continue operating or surrender facility license. Mr. John Menorca requested information on closure procedures. RM discussed the closure procedures. LPA Chochian will provide resources on facility closure procedures by email.
Exit conducted copy of report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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