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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610307
Report Date: 08/19/2022
Date Signed: 08/19/2022 01:41:57 PM


Document Has Been Signed on 08/19/2022 01:41 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:VILLA GRANADA ASSISTED LIVINGFACILITY NUMBER:
197610307
ADMINISTRATOR:YAZICHYAN, EMANUELFACILITY TYPE:
740
ADDRESS:17412 TILFORD CTTELEPHONE:
(818) 282-4122
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 4DATE:
08/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Emannuel Yazichyan/ AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct a pre-licensing inspection of the home The LPA was able to meet with the facility administrator. This is a change of ownership.

This home is a 4 bedroom 2 bath home. The fire clearance was approved for 1 bedridden resident and 5 non-ambulatory residents. All smoke alarms and carbon monoxide detectors appeared functional. The fire extinguisher in the kitchen also appeared functional.

Component III Conducted. Pre-licensing Inspection tool review all eleven inspection domains, no deficiencies were observed.

This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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