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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850091
Report Date: 08/12/2026
Date Signed: 08/12/2026 05:57:48 PM

Document Has Been Signed on 08/12/2026 05:57 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:PRESERVE AT WOODLAND HILLS, THEFACILITY NUMBER:
195850091
ADMINISTRATOR/
DIRECTOR:		SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:6221 FALLBROOK AVENUETELEPHONE:
(747) 226-5834
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 60CENSUS: 50DATE:
08/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:49 AM
MET WITH:Susan WeisbarthTIME VISIT/
INSPECTION COMPLETED:
06:05 PM
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Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 09:49 AM. The LPAs met with Health and Services Director (HSD) Tony Nunez and Executive Director (ED) Susan Weisbarth and explained the reason for the visit. Entrance interview conducted.

At 10:38 AM, the LPAs and HSD toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed:

COMMON AREAS: The facility is a one-story building that contained a lobby, offices, kitchen, storage, and employee lounge which was inaccessible to residents. The remainder of the facility had a dining room, activity room, day room, activity office, salon, medication room, and an outdoor courtyard. The LPAs observed common areas to be clean and in good condition. There were no obstructions and/or tripping hazards throughout the facility. Areas that posed a safety risk to residents were observed to be locked.

Required postings were found in the lobby and throughout the facility hallways. There were fire extinguishers throughout the facility, which were fully charged and last serviced 05/18/2026 and contained emergency flashlights. There are three (3) delayed egress doors throughout the facility. LPAs tested a delayed egress door at 11:53 AM which functioned properly. Staff responded to the alarm promptly at 11:53 AM.

The courtyard contained a raised garden bed, activities for residents, and furniture in good condition with shade. Emergency food and water were stored in an outdoor utility closet along with general storage. The LPAs also observed the emergency side exits. Report Continued on LIC 809-C.

Kristin Heffernan
Angela Barutyan
DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 08/12/2026
NARRATIVE
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RESIDENT ROOMS: Beginning at 10:42AM, the LPAs observed ten (10) randomly selected resident rooms. Appropriate furniture and sufficient lighting were observed in the units. LPAs observed signal systems installed in the resident bathrooms. Resident restrooms were clean, with properly installed grab-bars and slip-resistant surfaces. Hot water temperature was measured in resident restrooms and was between 105.2-112.5 degrees F, which is within the required range. At 10:49 AM, LPAs tested the bathroom pull cord in room 147. LPAs waited for twenty (20) minutes with no staff response. LPAs informed staff and the signal was cleared at 11:13 AM, approximately twenty-four (24) minutes later. Staff stated that they review pull cord signals, however seven (7) different staff members were observed passing by room 147 with no response to the pull cord. LPAs tested the bathroom pull cord in room 102B at 11:16 AM and staff cleared the signal at 11:20 AM. Lastly, LPAs tested the bathroom pull cord in room 133B at 11:44 AM. LPAs waited for a response for eleven (11) minutes and by 11:56 AM, there was no staff response. LPAs reviewed response time records which documents that staff responded in eighteen (18) minutes to LPAs’ test signal. Further review of pull cord response times from 08/09/2026-08/12/2026 document staff response times to bathroom pull cords as long as eleven (11) hours.

KITCHEN: The facility’s kitchen was inspected and found to be in compliance with Title 22 regulations. The facility receives food deliveries two (2) times a week from US Foods. There was a sufficient supply of perishable and non-perishable food. Food in the freezer and refrigerator were observed to be of good quality.

MEDICATION REVIEW: Medications are centrally stored and locked in the facility’s medication office. Beginning at 03:30 PM, LPAs reviewed medications for five (5) residents. All medications reviewed were stored and documented per regulation.

RECORD REVIEW: Beginning at 03:42 PM, LPAs reviewed five (5) resident files and four (4) staff files for documents including but not limited to: resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident records reviewed were in compliance with regulation at the time of the visit. Two (2) out of four (4) staff files were incomplete as both were missing a health screening and TB test and one (1) was also missing first aid certification.

Report Continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
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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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 08/12/2026
NARRATIVE
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INFECTION CONTROL/DISASTER PREPAREDNESS: During today’s visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. All items reviewed were in compliance. The facility conducts emergency disaster drills quarterly, with the most recent drill documented on 07/22/2026. The community’s smoke detectors and carbon monoxide detectors are hardwired and were last tested on 12/18/2025 by GFP Services and approved by the Los Angeles Fire Department.

Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were reviewed and provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2026 05:57 PM - It Cannot Be Edited


Created By: Angela Barutyan On 08/12/2026 at 05:19 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(a)
Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, observation, and record review, the licensee did not comply with the section cited above as two (2) out of three (3) resident pull cords tested during the visit had staff response times ranging from 18-24 minutes, which poses a potential health and safety risk to clients in care.
POC Due Date: 08/19/2026
Plan of Correction
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Management stated that staff will receive training on signal response times. Proof of training will be sent to CCLD by due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2026 05:57 PM - It Cannot Be Edited


Created By: Angela Barutyan On 08/12/2026 at 05:19 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as two (2) out of four (4) staff files were missing a health screening and TB test and one (1) was also missing first aid certification which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/19/2026
Plan of Correction
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Management stated health screenings, TB test, and first aid will be completed. Proof will be sent to CCLD by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


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