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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609606
Report Date: 12/15/2022
Date Signed: 12/15/2022 10:22:18 AM

Document Has Been Signed on 12/15/2022 10:22 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:
12/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ani Hasmik MkrtchyanTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. The LPA was greeted by facility staff and had his temperature taken and all COVID-19 protocols were conducted before allowing the LPA entrance to the home. The administrator was called and arrived a short while later.

The infection control tool was used to complete this annual. The home consists of 4 bedrooms and 2 bathrooms. The smoke alarms were tested and functioned properly. The carbon monoxide detector was tested and functioned properly. A fire extinguisher was observed in the kitchen area and appeared functional.

The facility is currently following their infection control plan 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: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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