195850156-7-8-2026-29-AS-QHUH-DVSRN5-20260708130946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850156
Report Date: 07/08/2026
Date Signed: 07/08/2026 01:10:00 PM

Document Has Been Signed on 07/08/2026 01:10 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:	CNS QUAKERTOWN		FACILITY NUMBER:	195850156
ADMINISTRATOR/ DIRECTOR:	MARC SAINT CLAIR		FACILITY TYPE:	735
ADDRESS:	5135 QUAKERTOWN AVENUE		TELEPHONE:	(661) 872-3408
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY: 6		CENSUS: 5	DATE:	07/08/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:03 AM
MET WITH:	Marc Saint Clair - Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:20 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) Quoc Huynh arrived at the facility unannounced for a required one-year visit. LPA arrived at 10:06AM and met with the Administrator Marc Saint Clair. Entrance interview conducted. Beginning at 10:25AM, the LPA and Administrator conducted a tour of the physical plant to ensure clients’ health and safety, and the facility is in compliance with Title 22 regulations. The following was observed: COMMON AREAS: The common areas included the family room, dining room, and living room. All furniture were clean and in good condition. The family room had a screened fireplace. There was sufficient space to accommodate both indoor and outdoor activities. Required postings were observed in the family room and living room. The living room had secured staff storage and client medications. Nightlights were observed throughout the hallways. The facility also had a locked garage that contained emergency food and water, extra supplies, and general storage. There was a laundry room with machines in good condition and secured detergent. KITCHEN: Knives and cleaning supplies were stored inaccessible. Kitchen appliances and fixtures were clean and functional. The facility also had a sufficient supply of perishable and non-perishable food. Food in the refrigerator and freezer were of good quality and were labeled with dates. Report Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

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: CNS QUAKERTOWN	FACILITY NUMBER: 195850156
	VISIT DATE: 07/08/2026

NARRATIVE

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BEDROOMS/RESTROOMS: There were six (6) total client bedrooms, each private. Bedrooms were observed to have appropriate furniture, linens, and sufficient lighting. Bedrooms #1, #2, #3, and #4 had direct exits to the outside and approved for a total of four (4) bedridden clients. There were no visible hazards or inconsistencies observed. Extra linens were stored in each room. There were five (5) total restrooms: one (1) private and four (4) common area restrooms. All restrooms were observed to be clean and sanitary, supplied with appropriate paper products and displayed hand washing signs. Hot water temperature was tested and measured between 112.3 degrees F and 114.8 degrees F.

OUTDOOR AREA: The facility’s outdoor provided shaded areas with furniture in good condition. There was an exterior building that was utilized as a staff office/break room with a private restroom. A secured shed was observed that was utilized by the maintenance team. Exterior passageways were clean and clear of any obstructions. There were two (2) remote and manual operated driveway gates in addition to one (1) everyday door.

RECORD REVIEW: Record review began at 11:19AM. Client records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Client files reviewed contained all required documents. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed/updated annually. The facility conducts emergency drills as required, with the last drill documented in 03/24/2026. Fire extinguishers were observed throughout the facility and were last serviced on 11/25/2025. The facility’s fire alarm system was last inspected on 04/30/2026 by CINTAS Fire Protection.

Report Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC809 (FAS) - (06/04)

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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: CNS QUAKERTOWN	FACILITY NUMBER: 195850156
	VISIT DATE: 07/08/2026

NARRATIVE

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MEDICATION REVIEW: The LPA reviewed two (2) client medications at 12:29PM. Client medications were centrally stored and inaccessible in the living room. Medications were checked for labels, expiration dates, and were properly documented on the centrally stored medication and destruction record. No errors observed.

No deficiency cited. Exit interview conducted. A copy of today’s report was reviewed and provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC809 (FAS) - (06/04)

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