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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609666
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:36:48 PM


Document Has Been Signed on 03/22/2022 01:36 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:ROYALTY ASSISTED LIVING IIFACILITY NUMBER:
197609666
ADMINISTRATOR:AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:17326 LOS ALIMOS STTELEPHONE:
(818) 436-9088
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 5DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Estela Avetyan/ DirectorTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. The director was called and arrived a short while later. The LPA's temperature and all covid -19 related questions were asked before the LPA was allowed entry. LPA explained that he was here in order to conduct an infection control Annual.

The LPA was able to conduct a brief physical plant tour of the facility. Hand washing signs and all state notifications were observed posted on the facility walls. The smoke alarms were tested and functioned properly.

The facility is currently following their 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: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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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