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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609351
Report Date: 03/25/2026
Date Signed: 03/25/2026 12:15:11 PM

Document Has Been Signed on 03/25/2026 12:15 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GRANT SERENITY HOMES INCFACILITY NUMBER:
197609351
ADMINISTRATOR/
DIRECTOR:		MARTIN ADJIANFACILITY TYPE:
740
ADDRESS:409 WING STREETTELEPHONE:
(818) 425-6797
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 6CENSUS: 6DATE:
03/25/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Hasmik Mheryan, Administrator DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 03/25/26, at 9:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Gayan Ter Hovhannicyan, Caregiver was advised of the visit. Hasmik Mheryan, Administrator Designee was called and arrived about forty (40) minutes later.

LPA asked for the census, resident, and staff files.

The facility is a one (1) story home that has a total of five (05) bedrooms and two (02) bathrooms. The facility has a hospice waiver approved for six (06) residents approved on 03/2022.

Last fire drill/Fire Alarms were conducted on 12/2025. The living and dining room are neat and clean. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. There is a signal system in the house and cameras in the common areas. There is another fire extinguisher in the hallway observed to be full and dated 10/2025.

Kitchen is sufficiently stocked with at least seven (07) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Kitchen cabinets contain extra food. Knives and sharps are observed to be locked and inaccessible to residents in one (1) of the top cabinets on your left side. The medication is kept in the kitchen area locked and inaccessible to the residents in a white cabinet. The chemicals/toxins are kept under the sink locked and inaccessible to residents. There is one (1) fire extinguisher located in the kitchen, observed to be full and dated 10/2025.



LIC 809C-continued
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANT SERENITY HOMES INC
FACILITY NUMBER: 197609351
VISIT DATE: 03/25/2026
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Living Room and Dining Room: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The facility temperature is between 74 degrees Fahrenheit.

Bedrooms: Facility has five (5) bedrooms. Four (4) bedrooms are single occupied and one (1) bedroom is shared bedroom. All the bedrooms are currently occupied.

Bathrooms: There are two (2) bathrooms that have proper grab bars, non-skid mats. The bathrooms contained a trash can with tight-fitting lid. Hot water was tested and measured between 116.4 Fahrenheit within regulations.

Outside/Backyard: There is a detached garage where there is one (1) washer and dryer. There is an extra refrigerator in the garage. The outside/backyard has furniture for residents to have proper seating. There is a no pool/bodies of water.

Administrative: The administrative Certification is current and dated 08/27/27. There is a yes sign, Ombudsman, House Rules, Theft and Loss, Personal Rights, Emergency Disaster, the liability insurance is dated 07/04/26.

Staff/Resident Files: LPA reviewed six (6) resident files and three (3) staff files.

An exit interview was conducted, no citation(s) were issued and a copy of this report was given to the administrator designee.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC809 (FAS) - (06/04)
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