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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222639
Report Date: 09/03/2025
Date Signed: 09/03/2025 03:09:10 PM

Document Has Been Signed on 09/03/2025 03:09 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:ONEGENERATION - MARK TAPER J.O.Y. PROGRAMFACILITY NUMBER:
191222639
ADMINISTRATOR/
DIRECTOR:		ANNA SWIFTFACILITY TYPE:
775
ADDRESS:17400 VICTORY BLVD.TELEPHONE:
(818) 708-6625
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 90CENSUS: 73DATE:
09/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:39 AM
MET WITH:Anastasia PlyuginaTIME VISIT/
INSPECTION COMPLETED:
03:15 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
Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced required annual visit. Upon arrival the LPA met with Anastasia Plyugina- Adult Day Program Director and explained the reason for the visit. During today’s visit the census of participants was 32, and the total number of participants enrolled in the program is 73. The day-program hours are from 9:30 a.m. to 3:30 p.m. The LPA, and the Director 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 common areas consist of the lobby/reception area, observation areas and two Activity Rooms. The LPA observed required postings throughout the common space. The LPA observed daily activity calendars, and daily menus. ACTIVITY ROOMS: Two (2) Activity rooms, one large for exercise, meals, etc., and a smaller activity room for additional activities. At the time of the visit, the LPA observed participants engaged in musical and writing activities. Rooms were observed to be clean, and furniture was observed to be in good condition. Four (4) fire extinguishers were observed throughout the facility; fire extinguishers were last serviced on 06/25/2025. The facility maintained a comfortable temperature of 71 degrees. The smoke detector(s) and carbon monoxide devices were last tested by the Los Angeles Fire Department (LAFD) on 09/09/2024 and issued the Performance Report which is valid for two years with an expiration date of 11/30/2026. Emergency/Evacuation Drill was last conducted on 08/26/2025.

Continues on LIC 809C…

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2025
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 4
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 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: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM
FACILITY NUMBER: 191222639
VISIT DATE: 09/03/2025
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
KITCHEN: The kitchen area was observed to be clean and sanitary; appliances and fixtures were observed to be functioning during the time of the visit. Perishable and non-perishable foods were observed to be properly stored. The LPA observed a small refrigerator, in addition to the industrial size refrigerator. The small refrigerator is to store snacks and beverages for participants and their special meals. The industrial refrigerator is used to store meals delivered by the meal vendor. One industrial freezer was also observed in the kitchen area. Both the refrigerator’s and freezer’s temperature are logged in daily in a log sheet located on a plastic pocket protector taped to the door. The Dinning Coordinator receives the meals delivered by the food vendor. The food’s temperature is logged in on arrival and again at the time it will be served.

RESTROOMS: Restrooms were observed to be clean, sanitary and in operating condition with grab bars. The restrooms were sufficiently stocked with soap and paper towels. Hand washing signs were posted prominently. Trash cans were observed to have tight fitting lids.

LAUNDRY ROOM: It is located across the hall from the women’s restroom. Cleaning supplies and detergents were observed to be stored in this area and were inaccessible to clients during the visit.



NURSE STATION: Nurses’ station was observed to store medication, first aid, PPE, and all were observed to be inaccessible to clients.

OBSERVATION ROOM: The room was observed to be clean, and the furniture was observed to be in good condition.



REHABILITATION ROOM: The rehabilitation room was observed to be clean and furnished with appropriate equipment. During the visit, the LPA observed a resident receiving physical therapy being provided by …

OUTDOOR/PATIO: The patio has a shaded area and is equipped with furniture for clients' use. No bodies of water were noted. Outside area was observed free of clutter and obstruction. Parking is located in the front of the building. LPA did not observe any obstructions or hazards during the visit.

Continues on LIC 809C...pg.3

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM
FACILITY NUMBER: 191222639
VISIT DATE: 09/03/2025
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
pg.3

RECORDS: Records review began at 12:30 p.m. Residents’ records were reviewed for, but not limited to appraisals, medical records, admissions agreement, consent forms. Personnel records were reviewed for, but not limited to personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

MEDICATIONS: Medications review began at approximately 1:45 p.m. The medications are centrally stored in a medication cart located in the nurse’s station and inaccessible to the participants. The medications are
documented properly on the centrally stored medications and destruction record. No errors observed during the medication review.


The LPA reviewed the following documents:
- LIC500 Personnel Report
- LIC9020 Client Roster
- Certificate of Liability of Insurance
_ Emergency Drill Logs


Exit Interview Conducted. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4