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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220673
Report Date: 09/10/2025
Date Signed: 09/10/2025 04:35:37 PM

Document Has Been Signed on 09/10/2025 04:35 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:ROBINSON MANOR IIFACILITY NUMBER:
191220673
ADMINISTRATOR/
DIRECTOR:		RETHA DE JOHNETTEFACILITY TYPE:
735
ADDRESS:628 ROYCE STREETTELEPHONE:
(626) 791-2486
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 10CENSUS: 6DATE:
09/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator, Retha De Johnette & Licensee, Laura RobinsonTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Analyst Program (LPA) Antonia Alvizar-Ettima conducted an unannounced subsequent visit at the above address to confirm client’s relocation, reduced the capacity and compliance with fire regulations. LPA met the Administrator, Licensee granted entry.

At about 9:20a.m. the LPA and Administrator toured the home and confirmed that the clients were relocated, and the facility’s capacity was reduced from ten (10) to six (06) clients.

Prior to today’s visit, on 09/03/25 LPA contacted facility via-phone for an update on the clients that were needed to be temporarily relocated. Administrator confirmed that clients were temporarily relocated with the assistance of the Regional Center and family members.

At the time of this visit, LPA inspected the property and observed two (02) shared bedrooms, two (02) private bedrooms and a staff office with a bathroom. The clients that needed to be relocated were not present at the facility. The three (03) out of four (04) clients were relocated to other facilities. One (01) client is residing at this house since the previous census of the facility was five (05) and keeping one (01) client will make it a total census of six (06). The administrator indicated they contacted the Regional Center immediately upon receiving the citation on 08/20/25. They indicated that client #1 (C1) was relocated on 08/23/25, client #2 (C2) was relocated on 09/01/25 and client#3 (C3) was relocated on 09/02/25.

Although the evacuation orders were lifted on or around February 2025 (depending from geographical locations, the first phone discussion between the Administrator and CCLD regarding capacity decrease was on 04/15/25, at which time the Administrator was notified by the Licensing Program Manager(LPM), Naira


Cont. on LIC 809- C
NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2025
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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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: ROBINSON MANOR II
FACILITY NUMBER: 191220673
VISIT DATE: 09/10/2025
NARRATIVE
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Margaryan that evacuation order is lifted and the Licensee needed to bring facility back to the original capacity.

The 2nd follow up call was made on 05/16/25 at which time LPM Margaryan spoke with the Licensee Laura Robinson and explained about over capacity. Licensee was notified about upcoming annual inspection and was advised to contact to San Gabriel/Pomona Regional Center to discuss temporary relocation because capacity waiver is no longer valid. The Licensee also was advised to inform CCL when the clients are relocated.

The same information was disclosed to the Administrator, a few days later over the phone. The Administrator was notified about previous phone conversation with the Licensee. The Administrator also was notified that the capacity must be decreased back to the original condition. Both the Licensee and the Administrator were notified that continued non-compliance (operating over original Licensed capacity) may bring to the citations and Civil Penalties.

On 08/13/25, during Annual Inspection visit, LPA Antonia Alvizar - Ettima had the last discussion regarding over capacity and once again the Administrator was informed about the outcome of continued non-compliance.

On 08/20/25 the Case Management visit was conducted, and it was observed that the facility continued to operate over capacity. The Licensee and/or the Administrator contacted the Regional Center after receiving citation and civil penalties for operation out of scope of original Licensed capacity.

Although, the Licensee/Administrator had knowledge of the issue for at least 3 months or more, the Licensee and/or the Administrator did not make any contact to Regional Center to relocate the clients as it was previously discussed. They contacted Regional Center after Licensing visit conducted on 08/20/25, when they receive Citations and Civil Penalties.

Based on the information provided by the Administrator regarding the dates of clients’ relocation, additional citation and Civil Penalties will be issued at the time of this visit. Due to computer error LPA provided manual Civil Penalty Assessment.

No other health and safety hazard is noted during this visit.

Exit interview was conducted, appeal right discussed, and a copy of report issued.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2025 04:35 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Antonia Alvizar-Ettima On 09/10/2025 at 01:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROBINSON MANOR II
FACILITY NUMBER: 191220673

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/10/2025
Section Cited
CCR
80054(f)

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80054 (f) Penalties. If any deficiency is not corrected by the date specified in the notice of deficiency, a penalty shall be assessed for each day following that date until compliance has been demonstrated
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At the time of this visit LPA was informed that as of 09/02/2025, the facility started operating based on the original Licensed capacity. Therefore, the citation was cleared during this visit.
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Based on the previous conversations with the Administrator after the Emergency Evacuation Order was lifted, they continued to operate out of scope of original License capacity until 09/02/2025. This possesses an immediate health and safety hazard to clients in care.
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Additional Civil Penalties were issued based on the dates clients were relocated. Between 8/21/25 to 8/22/25, for 3 clients. Between 8/23/25 to 9/1/25, for 2 clients. On 9/1/25, for 1 client & moved out on 9/2/25. Penalty is $100 a day per client.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Antonia Alvizar-Ettima
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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