197609748-10-3-2024-31-AS-MCAA-D9PR48-20241003124108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609748
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:41:13 PM

Document Has Been Signed on 10/03/2024 12:41 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 YEARS		FACILITY NUMBER:	197609748
ADMINISTRATOR:	ARUTYUNYAN, SEVAK		FACILITY TYPE:	740
ADDRESS:	17201 LAHEY ST		TELEPHONE:	(818) 535-9693
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 3	DATE:	10/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Rita Balasanyan		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the staff, Rita Balasanyan and explained the reason for the visit. The administrator, Mariam Balasanyan, was notified over the telephone. Administrator could not make the visit at this time. The facility is a one story building, licensed to serve clients sixty years of age and above. At approximately 9:00am, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detector is dual and are hardwired. There is a fully charged fire extinguisher that is located near the dining room. It was purchased September 29, 2024. 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 are four (4) bedrooms designated for residents' use. The bedrooms, in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms. One bathroom designated for residents, and one designated for staff. The bathrooms used by residents were properly supplied and had functional fixtures. Hot water temperature was measured at 107 degrees Fahrenheit. There were no cleaning supplies or hazardous items observed in the bathrooms. Common Areas: These included the living room, family room and dining area. The living room is furnished with a couch, recliner, two chairs, large chest drawer, television and a large ottoman footstool. There is a fireplace that is properly screened with glass door. Fireplace is non-functional, and no tools were present.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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: GRANADA GOLDEN YEARS	FACILITY NUMBER: 197609748
	VISIT DATE: 10/03/2024

NARRATIVE

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The family room has two sofas a chair, a coffee table, another small table and a television. Access to the backyard is through the family room. The dining room table is large enough to seat up to six residents. Auditory alarms on all exit doors were on and functional at the time of the visit.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use.

Garage: The garage is attached to the house. It is used as storage. Garage was kept locked and inaccessible to residents during the day's visit.

Laundry: The laundry area is located by the kitchen. There is a locked cabinet by the laundry area where detergents and cleaning supplies are kept.

Resident Files: Resident records are kept locked in a cabinet in the family room. LPA conducted a file review of resident records to insure compliance.

Staff Files: Staff records are also kept locked in a cabinet in the family room. LPA conducted a file review of staff records to insure compliance.

Medications: Medications and medication records are kept locked in a cabinet located at the family room. Medication and Medication Records were reviewed for proper storage and 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 Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC809 (FAS) - (06/04)

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