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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609748
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:58:45 PM


Document Has Been Signed on 06/07/2022 01:58 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:GRANADA GOLDEN YEARSFACILITY NUMBER:
197609748
ADMINISTRATOR:ARUTYUNYAN, SEVAKFACILITY TYPE:
740
ADDRESS:17201 LAHEY STTELEPHONE:
(818) 535-9693
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 5DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sevak Arutunyan/ AdministratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. Staff took the LPA's temperature before allowing the LPA to enter the home. Staff was observed to be wearing a mask.

The home has 4 bedrooms and two bathrooms. The smoke alarms appeared to be functional, as well as the carbon monoxide detector. The fire extinguisher was purchased on 5/19/2021 and appeared to be functional. Hand sanitizer, masks and gloves were also observed in the entry of the facility.

The facility is currently following their mitigation plan and no deficiencies were observed during todays visit. 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: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022
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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