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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609876
Report Date: 09/27/2021
Date Signed: 09/27/2021 10:48:28 AM

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:A-1 ASCENDED SENIOR CAREFACILITY NUMBER:
197609876
ADMINISTRATOR:TOPCHYAN, HARUTFACILITY TYPE:
740
ADDRESS:16444 GERMAIN STREETTELEPHONE:
(818) 667-4915
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Harut Topchyan/ AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct a required annual visit. LPA was greeted by facility staff, who were observed wearing masks and took LPA's temperature upon entry. The administrator was called and arrived a short while later.

The home was inspected for health and safety issues and a brief tour was conducted . The home has 5 bedrooms of which one room is shared. The home appeared clean and sanitary. There was a sufficient amount of perishable and non perishable food at the home properly stored. The water temperature was tested and was read at 108.6 degrees Fahrenheit. Smoke alarms and carbon monoxide detectors were present and function properly.

The facility is currently following their mitigation plan. No deficiencies were issued during this 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: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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