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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607821
Report Date: 09/30/2022
Date Signed: 09/30/2022 12:59:28 PM

Document Has Been Signed on 09/30/2022 12:59 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:ZION RESIDENTIAL CAREFACILITY NUMBER:
197607821
ADMINISTRATOR:ARTHUR AGUILARFACILITY TYPE:
740
ADDRESS:16654 SAN FERNANDO MISSION BLVTELEPHONE:
(818) 620-2202
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 4DATE:
09/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jenneth Aguilar - AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the home and was greeted by the facility administrator. The LPA explained that the visit was to conduct an Infection Control Annual. The LPA had his temperature checked and COVID-19 questions asked prior to being allowed entry.

The home consists of 5 bedrooms and two bathrooms. One bedroom is for staff use only. The smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguisher was observed and was purchased in February of 2022.

The home appeared clean and sanitary and no deficiencies were observed during the visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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