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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610151
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:02:14 AM

Document Has Been Signed on 01/10/2025 11:02 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:AEGIS LIVING GRANADA HILLSFACILITY NUMBER:
197610151
ADMINISTRATOR/
DIRECTOR:
LANCE SHENKFACILITY TYPE:
740
ADDRESS:10801 LINDLEY AVETELEPHONE:
(818) 363-3373
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 100CENSUS: 80DATE:
01/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Lance ShenkTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Michael Cava conducted a Case Management (CM) visit to the facility to follow up on an Incident Report received on 12/14/24, pertaining to R1's personal rights. LPA met with the administrator, Lance Shenk, and advised him of the visit. Today's CM visit consisted of interviews with the administrator, staff and Resident 1 (R1). LPA also made a physical plant inspection and conducted a record review.

According to the IR, the incident occurred on or around 12/14/24, at approximately 8:10am. R1 was interviewed by administrator and Health Service Director (HSD). Law Enforcement (LE) was also notified and a Battery Report (#24096208) was taken. LE indicated that they will not be conducting any further investigation based on their conversation with R1.

Today, interviews made with administrator and Wellness Nurse. Administrator confirms no further interviews from LE based on their initial investigation. R1 is still at the facility. Facility made an internal investigation, which was deemed Inconclusive. R1 was sent immediately to the hospital after the alleged incident on or around 12/14/24. R1 was diagnosed with UTI, which caused some confusion. New orders prescribed at discharge. R1 is back at the facility. Family notified, and no concerns made.

Based on the information obtained, it does not appear R1's personal rights were violated. No citations issued as the licensee satisfied their reporting requirements. Administrator was advised and a copy of this report issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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