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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609876
Report Date: 11/08/2022
Date Signed: 11/08/2022 10:37:22 AM


Document Has Been Signed on 11/08/2022 10:37 AM - 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: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: 4DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Harut Topchyan/ AdministratorTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. LPA had his temperature taken at the door and was asked the COVID-19 questions. Staff was observed wearing masks. The LPA explained the reason for the visit and the administrator was called. The administrator arrived a short while later.

The inspection tool was used to complete this infection control annual. The LPA was able to briefly tour the home for any immediate health and safety concerns. The smoke alarms and carbon monoxide detectors were tested and functioned properly. The facility is following their infection control plan and no deficiencies were observed during the 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: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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