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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610151
Report Date: 06/14/2022
Date Signed: 06/14/2022 11:06:28 AM


Document Has Been Signed on 06/14/2022 11:06 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:AEGIS LIVING GRANADA HILLSFACILITY NUMBER:
197610151
ADMINISTRATOR:MATTHEW LA VINEFACILITY TYPE:
740
ADDRESS:10801 LINDLEY AVETELEPHONE:
(818) 363-3373
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:100CENSUS: 79DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Bernadette Teodorescu / Health Services DirectorTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. Before being allowed entry, the LPA was directed to a kiosk where all COVID-19 related questions were asked and the LPA's temperature was taken. Once cleared, the LPA was given a visitors badge and the administrator was notified the reason for the visit.

A tour of the physical plant was conducted with the LPA and the Health Services Director. The LPA observed that there were multiple hand sanitizing stations throughout the facility. All COVID-19 related signs were observed posted throughout the facility and hand washing signs were posted in the restrooms. All fire extinguishers were serviced on 6/8/2022.

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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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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