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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610083
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:47:36 PM

Document Has Been Signed on 08/16/2023 02:47 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:SAINT MARY'S RESIDENTIAL CAREFACILITY NUMBER:
197610083
ADMINISTRATOR:YEGEYAN, NAZARFACILITY TYPE:
740
ADDRESS:17177 1/2 SAN JOSE STREETTELEPHONE:
(818) 403-1803
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nazar YegeyanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted a Case Management (CM) visit to the facility to follow up on a concern reported to the licensing office. LPA met with the administrator, Nazar Yegeyan, and advised him of the concern. It was reported that Resident 1 (R1) has a condition that the licensee may not be able to meet their needs. According to the administrator, R1 can be aggressive and may tend to wander, but they are able to assist R1 in meeting their needs. Since admission, R1 has been compliant with house rules. Only concern is that R1 is late with rent. R1 hasn't paid rent the last three months. Family is aware. Administrator stated he is in the process of assisting R1 in getting some financial assistance to help pay their rent. LPA also advised administrator to contact the Long Term Care Ombudsman (LTCO) and Adult Protective Services (APS) for additional assistance. Interview with R1 reveal that they are satisfied with the care and supervision provided by facility staff. R1 also states and confirm that staff are able to meet their needs.

CM visit for follow up only. No deficiencies issued. Administrator advised and a copy of this report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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