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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609606
Report Date: 10/12/2021
Date Signed: 10/12/2021 10:36:52 AM

Document Has Been Signed on 10/12/2021 10:36 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:AURORA HOME FOR SENIORSFACILITY NUMBER:
197609606
ADMINISTRATOR:MKRTCHYAN, ANI HASMIKFACILITY TYPE:
740
ADDRESS:16346 SHAMHART DRIVETELEPHONE:
(818) 257-1457
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 3DATE:
10/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Ani Mkrtchyan/ AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct a Required 1 year Infection Control Annual. LPA was greeted by facility staff and had his temperature taken and was asked COVID -19 related questions. The administrator arrived a short while later.

A tour of the physical plant was conducted. The facility has four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one of which maybe bedridden on room #2 or #3. Hospice waiver for two (2) residents. There is a pool, which was observed to be locked with a 5 foot gate around the pool.

The home was also checked for fire safety. The smoke alarms and carbon monoxide detectors are hardwired and were tested to be functional. The facility is following their mitigation plan and all of the COVID -19 protocols.

No deficiencies were cited during the visit. Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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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