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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222099
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:23:28 PM

Document Has Been Signed on 04/26/2022 12:23 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TOMANENG GUEST HOME #3FACILITY NUMBER:
191222099
ADMINISTRATOR:TOMANENG, ESTELAFACILITY TYPE:
735
ADDRESS:10403 GERALD AVE.TELEPHONE:
(818) 366-3428
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Estela Tomaneng/ Administrator.TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct a an annual infection control inspection. LPA was greeted by the facility administrator. All staff were observed to be wearing masks and the LPA's temperature was taken upon entry.

LPA was able to tour the home and did not observe any immediate health and safety concerns. All smoke alarms were tested and functioned properly. The carbon monoxide detector was also tested and functioned properly. The fire extinguisher was observed in the living room and appeared functional.

The facility is currently following their mitigation plan and no deficiencies were observed on todays visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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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