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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850653
Report Date: 06/22/2026
Date Signed: 06/22/2026 02:37:58 PM

Document Has Been Signed on 06/22/2026 02:37 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:FACULTY HAPPY HOME CAREFACILITY NUMBER:
565850653
ADMINISTRATOR/
DIRECTOR:
ROSALES, KARENFACILITY TYPE:
740
ADDRESS:196 FACULTY STTELEPHONE:
(818) 219-5998
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 0DATE:
06/22/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Karen Rosales TIME VISIT/
INSPECTION COMPLETED:
02:32 PM
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Licensing Program Analyst (LPA) Erica Mosley conducted a Pre-licensing visit at 10:30 a.m. and met with the Applicant Karen Rosales. This is a new facility. The application is for a Residential Care Facility for the Elderly (RCFE), for five (5) non-ambulatory residents and one (1) bedridden resident. The pending facility has a Dementia Care Program. Fire Clearance was approved on 10/16/2025. Age range sixty (60) and over. Approved for six (6) residents of which one (1) may be bedridden and five (5) may be non-ambulatory. Bedroom #1 approved for single bedridden resident. All bedrooms approved for non-ambulatory residents. Hospice waiver pending for six (6) residents. The facility is a single story home located in a residential neighborhood.
At 10:35 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations.

COMMON AREAS: The facility has two (2) living rooms which were equipped with a television and were furnished appropriately. LPA observed a billiards table for resident use. Required documents were posted in the common hallway adjacent to the entrance. The emergency telephone numbers are posted in the common hallway. At 11:07 a.m. smoke, fire door and carbon monoxide alarms were tested and functioned properly at the time of the visit. Medications will stored and locked in a cabinet adjacent to the kitchen along with the residents’ and staff files. Activities were observed in the common areas.
GARAGE /LAUNDRY: The garage is adjacent and accessible through the larger living room / great den which will remain locked at all times. The garage is split in two (2) rooms. The first room is the laundry room which is equipped with a washer, dryer and detergents. The garage / second room is and will be used as storage. Emergency water is also located in the garage.
Report Continued on LIC 809-C PAGE 2...
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2026
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FACULTY HAPPY HOME CARE
FACILITY NUMBER: 565850653
VISIT DATE: 06/22/2026
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(PAGE 2) Report Continued from LIC 809-C...KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen cabinet. The facility has a sufficient supply of seven (7) day non-perishable food that was checked for expiration dates. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 111.0 degrees Fahrenheit within the required range. Trash cans have a tight-fitting lids. There were no pesticides or toxins stored near food, or preparation areas. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. There are multiple fire extinguishers throughout the facility, the main fire extinguisher is located in the living room, which was purchased on 10/17/2025. Auditory alarms at the entrances and exits were observed and functional at the time of the visit.

BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room will be kept locked at all times. All passageways were observed to be clear of obstructions. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet.

BATHROOMS: There are four (4) full bathrooms. Three (3) common, shared resident bathrooms, and one (1) private, resident bathroom. Bathrooms are equipped with toilet and shower grab bars, and slip resistant surface / mat. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water temperature was recorded between the range of 110.8- 111.0 degrees Fahrenheit all within the required range.

SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were relatively clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. Only one (1) , The North, passageway is used as an emergency exit which was free of obstructions at the time of the visit. The North passageway has a self-latching gate. The self-latching mechanism is located inside the gate.


Report Continued on LIC 809-C PAGE 3...
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2026
LIC809 (FAS) - (06/04)
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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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FACULTY HAPPY HOME CARE
FACILITY NUMBER: 565850653
VISIT DATE: 06/22/2026
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(PAGE 3) Report Continued from LIC 809-C PAGE 2...

INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard.

At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, and email address. Licensee Representative added a facility phone number and confirmed that all information is accurate.

During todays visit the applicant completed Component III orientation.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating under the new license until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect the approval of your license.

Pre-Licensing is complete. No citations issued. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2026
LIC809 (FAS) - (06/04)
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