<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603100
Report Date: 03/06/2024
Date Signed: 03/06/2024 03:19:03 PM

Document Has Been Signed on 03/06/2024 03:19 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLCFACILITY NUMBER:
198603100
ADMINISTRATOR:TOPADZUIKYAN, EMMAFACILITY TYPE:
740
ADDRESS:1444 WESTERN AVETELEPHONE:
(818) 245-6614
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 5CENSUS: 5DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Emma Topadzuikyan, AdministratorTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Rosaura Valenzuela and Leizl De La Cera conducted an unannounced Case Management visit in conjunction with complaint control number 31-AS-20240301091558. The purpose of this Case Management visit is for deficiencies observed during the course of the complaint investigation that is not directly related to the complaint. LPA met with Emma Topadzuikyan,,Administrator.

During the investigation, LPA Valenzuela and LPA De La Cera observed the following:

1) Resident #1(R1) has a stage 4 pressure injury.

2) R1 has dementia and the last time she was reappraised was in June of 2019.

3) Hospice records incomplete for R1 and R2.

4) Resident #1 and #2 (R2)'s facility files are incomplete

5) Incident reports for both R1 and R2 not submitted to licensing.

6) Hospice notification for both R1 and R2 not submitted to licensing.

7) Lack of Administrator qualifications

Due to time constraints, citations will be issued on a following visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1