<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610638
Report Date: 06/09/2026
Date Signed: 06/09/2026 02:22:23 PM

Document Has Been Signed on 06/09/2026 02:22 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:CHATSWORTH COMMONS SENIOR LIVING, LLCFACILITY NUMBER:
197610638
ADMINISTRATOR/
DIRECTOR:		MONROY, DAVIDFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE ST.TELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 268CENSUS: 164DATE:
06/09/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:David Monroy, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 9:35am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual visit. LPA met with the Administrator, David Monroy, and explained the reason for the visit.

The facility is a two-story building, though the second-floor rooms are numbered 200–400 despite there being no third or fourth floor. The Certificate of Occupancy confirms the first floor is designated for non-ambulatory residents and the second floor for ambulatory residents, only. A Fire Clearance approved on 09/05/2025 authorizes a total capacity of 268 residents: 134 ambulatory, 124 non-ambulatory, and 10 bedridden in rooms 107, 111, 119, 121, 123, 127, 161, 163, 165, and 167.

At 9:50am, LPA conducted the physical plant tour and observed the following:

COMMON AREAS: Upon entry, LPA observed facility license to be posted in a conspicuous area along with the complaint poster and personal rights, including other required postings. The facility maintains a comfortable temperature at 75°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of 268 residents. In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. This included living room furniture, a television, tables and chairs and a dining area. There is a functioning telephone on the premises. LPA was informed that the facility has three (3) libraries, two (2) activity rooms, a movie theater. Facility has four (4) medication carts throughout the facility (cart #1 by room #302, cart #2 by room #179, cart #3 by room #140 and cart #4 by room #224) and LPA observed all carts locked and inaccessible to residents.. Smoke and carbon monoxide detectors were located throughout the facility and are tested annually by the Fire Department. Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHATSWORTH COMMONS SENIOR LIVING, LLC
FACILITY NUMBER: 197610638
VISIT DATE: 06/09/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA obtained a copy of the fire inspection report (dated on 04/13/2026) on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide and smoke detectors.

KITCHEN: The kitchen and dining area are on the ground floor. The kitchen was observed to be fully stocked with perishable and nonperishable foods, clean, sanitary, and free of pests, with no food stored near cleaning supplies. Food is replenished at least twice weekly. Dietary needs for specific residents are clearly posted with photos and required preparations. Sharp objects are securely locked and inaccessible to residents.

BEDROOMS: There are 170 bedrooms designated for residents’ use. Rooms consist of single or shared occupancy. Bedrooms were randomly inspected and found to be properly furnished with appropriate linens, clean and sanitary conditions, and adequate closet space.

BATHROOMS: Bathrooms were inspected and found to be clean, properly stocked with towels and soap, and equipped with required nonskid mats and grab bars. Hot water temperatures measured between 117.3°F and 121.1°F.

LAUNDRY ROOM: The upstairs and downstairs laundry rooms were observed to have washers and dryers in good condition, and all laundry supplies were securely locked and inaccessible to residents.

SURROUNDING GROUNDS: The driveway serves as a large guest drop-off parking area. The facility has ample backyard space with appropriate outdoor furniture and a covered shaded area for residents. No bodies of water were observed. All indoor and outdoor passageways and stairways are free of obstructions, and LPA observed four facility stairways are equipped with evacuation chairs.

Between 12:00pm to 2:00pm, LPA reviewed records of fourteen (14) residents and five (5) staff. Client and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500.

No citations were issued during this visit.

Exit interview conducted and copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3