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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602651
Report Date: 03/10/2025
Date Signed: 03/10/2025 01:15:35 PM

Document Has Been Signed on 03/10/2025 01:15 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:TULSA HOME OF GRANADA HILLSFACILITY NUMBER:
197602651
ADMINISTRATOR/
DIRECTOR:		MICHAEL LEWANDOWSKIFACILITY TYPE:
735
ADDRESS:16430 TULSA STREETTELEPHONE:
(818) 360-3141
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 4DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Margaret ItchonTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 03/10/25, 9:25AM Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced Annual Required visit to this facility. LPA met with caregiver, Rodel Mayuga. Rodel Mayuga called the Administrator, Megaret Itchon, who arrived thirty minutes (30) later.

LPA conducted a physical tour and observed the following: This is a one (1) story house, Level 2 for clients.

Bedroom and Bathrooms: Facility has three (3) clients bedrooms and one (1) staff bedroom: Two (2) private rooms and one (1) shared room for clients. An additional bedroom is designated for staff use. Facility has two (2) bathrooms. One (1) bathroom has a shower and the other bathroom does not.
All bedrooms are properly furnished. The bathrooms have proper toiletry and grab bars. There is an extra closet in the hallway with extra linen. The bathroom hot water temperature measured at 110.1°F

Kitchen area was observed to be clean. The refrigerator is fully stacked. There is food storage and supply perishable and seven (7) day supply of nonperishable foods were observed. The kitchen food supply was observed and sufficient for the four (4) clients currently residing there. There is an excess of perishables in several of the cabinets.

The sharps and toxins are kept locked and inaccessible to the clients on your left-hand side of the entrance of the facility. There is one (1) fire extinguisher on the kitchen counter. The fire extinguisher has a purchase date of 02/2025 and fully charged. There is also a fire blanket.

LIC 809C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TULSA HOME OF GRANADA HILLS
FACILITY NUMBER: 197602651
VISIT DATE: 03/10/2025
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Living room area maintains sufficient lighting. Furnishings, exercise equipment, games, and reading materials were accessible to the clients. This area leads to the garage and backyard area. Medication was observed to be inaccessible and stored in a secured cabinet. There is a complete First Aid kit is accessible and stored in the living area desk cabinet in the living room area. There is also a fire place that has a black fence around it.

There is also a dining room area that has seating available for four (4) clients.

Temperature of facility wall thermostat displayed setting of 68.0°F.



The smoke detectors were tested and functioning properly along with the carbon monoxide. There is one (1) washer and dryer. The detergents/chemicals our on the top shelf locked and inaccessible to the clients.

Garage is attached to the house and observed to be locked and inaccessible to clients. Garage is also used as storage for frozen foods, extra water and PPE supplies. There is an extra refrigerator and freezer with food.

Backyard: There is a table set and chairs for clients use. There is enough seating for four (4) clients. There is no pool or any bodies of water.

Administrative: There is no annual fee due. The surety bond/Insurance plan are updated and expire May 17, 2025. The YES sign, Disaster Plan, Client Roster, Administrator License.



Exit interview conducted and a copy of this report was given to the Administrator, no citation(s) were issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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