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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222083
Report Date: 07/29/2025
Date Signed: 07/29/2025 03:38:07 PM

Document Has Been Signed on 07/29/2025 03:38 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:LIGHTHOUSE, THEFACILITY NUMBER:
191222083
ADMINISTRATOR/
DIRECTOR:		GABRIELA VISOVANFACILITY TYPE:
740
ADDRESS:10406 MAGNOLIA BLVD.TELEPHONE:
(818) 766-3764
CITY:TOLUCA LAKESTATE: CAZIP CODE:
91601
CAPACITY: 49CENSUS: 24DATE:
07/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Gabriela VisovanTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 01:30 PM. LPA met with the facility Administrator Gabriela Visovan, entrance interview conducted and the reason for the visit was explained.

Beginning at 01:33 PM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are twenty-seven (27) bedrooms in the facility; all are designated for resident use. LPA and facility Administrator toured ten (10) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS: Each bedroom in the facility has an attached private resident bathroom. Additionally, there is a shared resident bathroom and a shared shower room in the hallway of the facility. LPA and Administrator observed ten (10) private resident bathrooms, the shared resident bathroom and the shared shower room. Bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed next to all toilets and in all showers and all were properly secured. The water temperature was measured between 108.5 and 110.5 degrees Fahrenheit, which is in compliance with regulation.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIGHTHOUSE, THE
FACILITY NUMBER: 191222083
VISIT DATE: 07/29/2025
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COMMON AREAS: This includes the common activity room, hallway, and dining room areas. LPA observed the common activity room to be clean and properly furnished at the time of the visit. The common activity room contained a television and activities for residents’ use. The dining room contained adequate seating and was observed to be clean. Cameras were observed in the common areas and hallways throughout the facility. LPA observed the hallway to contain a dry food storage room, the locked medication room, the Administrator’s office, the common resident bathroom, and the shower room. Additionally the hallway was observed to contain additional fire extinguishers, the activity calendar, emergency exit sketches, and other required postings. The LPA observed fire extinguishers throughout the facility to be fully charged and last serviced on 02/14/2025. Smoke detectors and carbon monoxide detectors were last tested on 04/03/2025 and were functional at the time of the test.

KITCHEN: The LPA observed the kitchen area to be clean and inaccessible to clients in care. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days’ perishable and seven (7) days non-perishable food. The facility has an adequate supply of emergency food and water. The LPA observed one (1) designated cleaning supply cabinet to be locked and inaccessible to residents. The cleaning supplies were stored separately from food and cooking utensils.

OUTDOOR SPACE: The outdoor area has sufficient space for outdoor activities. The patio was observed to contain adequate patio furniture including shaded tables and chairs for residents’ use. LPA observed the locked laundry room to contain detergents and other cleaning supplies. LPA observed a locked storage room to contain tools, care supplies, and other chemicals. The patio of the facility has a small water fountain. The facility has an emergency exit gate, LPA observed clear passageways for emergency exit use.

INTERVIEWS: LPA interviewed three (3) staff and three (3) residents. All residents stated that staff treat them well and are attentive to their needs. Residents interviewed did not have concerns with the quality of care they received at the facility. All staff interviewed were knowledgeable on their roles and responsibilities, the residents’ rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s current liability insurance, employee roster, resident roster, fire alarm test record, and worker’s comp insurance.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LIGHTHOUSE, THE
FACILITY NUMBER: 191222083
VISIT DATE: 07/29/2025
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Due to time constraints LPA will return at a later date to conduct resident and staff file reviews, a medication audit, and a review of the facility’s emergency disaster plan and infection control plan.

No deficiencies were observed during today’s inspection. Exit interview conducted. And a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
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