191222593-6-26-2025-31-AS-JGTN-DHZQHX-20250626121153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222593
Report Date: 06/26/2025
Date Signed: 06/26/2025 12:12:04 PM

Document Has Been Signed on 06/26/2025 12:12 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	COMMUNICATION IMPROVEMENT GUIDANCE CENTER		FACILITY NUMBER:	191222593
ADMINISTRATOR/ DIRECTOR:	AGBEDE, SONNY		FACILITY TYPE:	735
ADDRESS:	15030 SEPTO STREET		TELEPHONE:	(818) 891-6555
CITY:	MISSION HILLS	STATE: CA	ZIP CODE:	91345
CAPACITY: 4		CENSUS: 4	DATE:	06/26/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:57 AM
MET WITH:	Sonny Agbede - Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:15 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	An unannounced One (1) Year Required visit was conducted on this day by Licensing Program Analyst (LPA) Jose Tan. LPA met with Licensee Sonny Agbede and explained the purpose of the visit. This is a North LA Regional center vendored facility Level IV-G. LPA conducted physical plant tour inside and out at 9:11 AM. During the tour, LPA observed that the facility has four (4) private client bedrooms and three (3) bathrooms. One (1) bathroom is designated for staff use. There is no body of water at the facility. The front main door is the only entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. The facility had submitted and approved Mitigation and Infection Plan. Bedrooms were toured and observed to be clean and furnished. Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature was measured at 112.6°F. Physical plant was checked for cleanliness and condition. Facility was observed to be generally in good repair and clean during today's visit. Living and dining room furniture were also checked for functionality (wear and tear). The furniture were observed to be in good condition. (continued on LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Jose Gary Tan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025

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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMUNICATION IMPROVEMENT GUIDANCE CENTER	FACILITY NUMBER: 191222593
	VISIT DATE: 06/26/2025

NARRATIVE

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(continued from 809)

Kitchen area was observed to be clean and sanitary. All disinfectants, cleaning solutions, poisons and sharps were locked in the cabinet located at the far end of the kitchen. Food. The facility is observed to have sufficient food supply for clients. Temperature of facility wall thermostat was set at 75.0°F and observed to be within the required range.

Fire extinguisher was located at the kitchen, it was last serviced on 05/14/25. Fire alarms were observed to be hardwired and interconnected. Carbon monoxide was observed to be installed and all alarms were tested and observed to be working.

Garage is attached to the house but has no access from the inside. Garage is currently being used as frozen food, PPE and old equipment storage. Cleaning solutions and laundry detergents are observed kept in the locked garage. Laundry area is located in the backyard.

Medication were observed to be locked, inaccessible and stored in the file cabinet in the staff room. Medication records and procedures reviewed with staff. First aid kits were observed to be complete with all the required items.

Client records were reviewed for current IPP (Individual Program Plan) and/or Needs and Service plans, physician report, admission agreements and P & I funds. Client records appeared to be complete and current. Staff records were also reviewed. Staff present have criminal record clearances and associated to this facility. Current training and first aid/CPR observed for staff on duty.

Disaster drill was last conducted on 05/11/25. Required posting observed in facility (complaint hot line poster).

There is no deficiency observed during today's inspection. Exit interview conducted. Copy of this report issued.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Jose Gary Tan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025

LIC809 (FAS) - (06/04)

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