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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604295
Report Date: 03/21/2022
Date Signed: 03/21/2022 12:33:43 PM

Document Has Been Signed on 03/21/2022 12:33 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:MCLENNAN GUEST HOMEFACILITY NUMBER:
197604295
ADMINISTRATOR:MARILYN SHIRAZIFACILITY TYPE:
735
ADDRESS:12139 MCLENNAN ST.TELEPHONE:
(818) 832-5523
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 4DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maralyn Shirazi/ AdministratorTIME COMPLETED:
12:48 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. The administrator was at the home and took the LPA's temperature and followed the COVID-19 protocol before allowing the LPA entry.

LPA was able to briefly tour the facility for health and safety concerns and none were observed. All staff members were observed to be wearing masks. The fire extinguisher was in the green and appeared functional.

No deficiencies or concerns were observed during this visit.

Exit Interview conducted and report issued..
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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