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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609606
Report Date: 02/17/2024
Date Signed: 02/17/2024 04:13:25 PM


Document Has Been Signed on 02/17/2024 04:13 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:AURORA HOME FOR SENIORSFACILITY NUMBER:
197609606
ADMINISTRATOR:MKRTCHYAN, ANI HASMIKFACILITY TYPE:
740
ADDRESS:16346 SHAMHART DRIVETELEPHONE:
(818) 257-1457
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 4DATE:
02/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Ani Mkrtchyan and explained the reason for the visit.

At approximately 1:00pm, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors are dual and interconnected. There was an extra carbon monoxide detector installed in the hallway by resident rooms. There are two fire extinguishers. One by the kitchen, and one by the kitchen. Purchase date is 03/15/23.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen.

Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are private and two (2) bedrooms are shared. LPA observed all four rooms properly furnished with appropriate beddings and linens with sufficient lighting. LPA observed extra supplies of linens and towels stored in the hallway.

Bathrooms: There are two (2) bathrooms of which one (1) is designated for residents' use. The other bathroom is designated for staff. The bathroom designated for residents were properly supplied and had functional fixtures. Hot water temperature was measured at 107 degrees Fahrenheit. LPA did not observe any cleaning supplies accessible to the residents during the day's inspection.

Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. The floors were clean. Entrance/exits were clear of obstruction. The fireplace has a screen. Fireplace key and tools not accessible.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AURORA HOME FOR SENIORS
FACILITY NUMBER: 197609606
VISIT DATE: 02/17/2024
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Surrounding Grounds: Passageways at the front, back and side of the home were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool. LPA observed a fence, approximately five foot high all around, with a locked gate making it inaccessible for residents to enter.

Staff Station: There is a staff station located near the front entrance.

The garage: The garage is attached to the home and was observed to be locked during visit. The garage was currently being used as a laundry area and emergency water and other supplies storage.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: The locked medication cabinet is located at the front of the home near the garage. Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a copy of the Report Issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2024
LIC809 (FAS) - (06/04)
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