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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610553
Report Date: 08/28/2025
Date Signed: 08/28/2025 01:54:59 PM

Document Has Been Signed on 08/28/2025 01:54 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 OF GRANADA HILLS INCFACILITY NUMBER:
197610553
ADMINISTRATOR/
DIRECTOR:		GEVORKIAN, NVARDFACILITY TYPE:
740
ADDRESS:10879 LOUISE AVETELEPHONE:
(818) 425-6797
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
08/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Victoria Mejia, Diana CastellanosTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Victoria Mejia, and explained the reason for the visit. The administrator, Diana Castellanos, and another staff, Hasmik Mheryan, joined shortly after.

At approximately 9:15am, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke detectors and carbon monoxide are inter-connected and were located throughout the facility. The facility has two (2) fire extinguishers. One fire extinguisher is located by living room area, and the second one is in the kitchen. It was last checked on March 4, 2025. Earthquake and fire drill was last done on August 12, 2025.

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, oven/stove, and microwave to accommodate a maximum capacity of six (6). Knives and sharps were observed to be locked in a kitchen drawer and inaccessible. Cleaning supplies were stored locked underneath the kitchen sink.

BEDROOMS: There are six (6) bedrooms designated for residents’ private use. All bedrooms are furnished and well equipped with bed, night stand, chair, dresser, bedding, and extra linen. Rooms were observed to have sufficient lighting and closet space.

BATHROOMS: The facility has two (2) bathrooms, bathroom #1 designated for the residents’ use, bathroom #2 is designated for staff. The bathroom, designated to residents was observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 105°F degrees.
NAME OF LICENSING PROGRAM MANAGER: Angela J Whittaker
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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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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 OF GRANADA HILLS INC
FACILITY NUMBER: 197610553
VISIT DATE: 08/28/2025
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COMMON AREAS: The living and dining rooms were clean and properly furnished. The living room furniture were maintained and in good repair. The dining room table was large enough to seat up to six (6). There is no fireplace. Floors were mopped and clean. Hallways and passageways were clear of any obstruction. Auditory alarms in all entry/exits were tested and observed to be operational.

SURROUNDING GROUNDS: The front and back yards of the facility has sufficient yard space. LPA observed furniture, appropriate for outdoor use. The home is fenced all around, but no locks observed on exterior fence/gates. The facility has no bodies of water.

Laundry: The laundry room is located by the kitchen. Detergents and cleaning supplies are stored inside. The laundry room was was checked and observed locked during the visit.



Staff Workstation/Office: There is a staff workstation located by the living room where medications, staff and resident records are kept.

MEDICATION: Medications are kept in the staff office. Medication cabinet has a combination lock. Medication and medications records were checked for proper storage and documentation.


Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

GARAGE: The garage was converted to an ADU, but has it's own passageway and entrance. ADU has no direct interruption to the day to day operation of the facility

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit interview conducted and a copy of this report issued.

NAME OF LICENSING PROGRAM MANAGER: Angela J Whittaker
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC809 (FAS) - (06/04)
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