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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606973
Report Date: 04/18/2022
Date Signed: 04/18/2022 10:40:00 AM


Document Has Been Signed on 04/18/2022 10:40 AM - 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:FEMMS RESIDENTIAL HOMES IFACILITY NUMBER:
197606973
ADMINISTRATOR:FRUCTUOSA M. MORALESFACILITY TYPE:
740
ADDRESS:11811 PASO ROBLES STREETTELEPHONE:
(818) 217-4081
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
04/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Neil MoralesTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. All staff were observed wearing a mask upon entry

The home has 6 residents and all residents have private rooms. The smoke alarms and carbon monoxide detectors were all tested and functioned properly. The fire extinguisher was last serviced in May of 2021 and appeared functional.

The facility is currently following their approved mitigation plan and no deficiencies were observed. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
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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