195850202-3-12-2026-29-AS-ABAN-DS4U7L-20260312152009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850202
Report Date: 03/12/2026
Date Signed: 03/12/2026 03:21:01 PM

Document Has Been Signed on 03/12/2026 03:21 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:	PSYCLARITY HEALTH INC.		FACILITY NUMBER:	195850202
ADMINISTRATOR/ DIRECTOR:	BARSALOU, AARON		FACILITY TYPE:	772
ADDRESS:	22450 COLLINS ST		TELEPHONE:	(832) 312-9611
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 6		CENSUS: 5	DATE:	03/12/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:34 AM
MET WITH:	Hayle Jimenez		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:34AM. LPA met with staff, Director of Operations Hayle Jimenez and Clinical Supervisor Shalmar Neal who arrived shortly thereafter. Entrance interview conducted.

Beginning at 10:35AM, LPA, along with Director of Operations, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed:

KITCHEN/GARAGE: LPA toured the facility kitchen at 10:35AM. Knives are stored inaccessible in the staff office along with medication. Cleaning supplies are stored inaccessible and away from all food preparation areas. Kitchen appliances were in operable condition. Management indicated lunch and dinners are catered from a third party company and clients can prepare their own meals with staff supervision. The facility has a sufficient supply of perishable and non-perishable food. LPA observed the attached garage, which was locked and contained extra food, emergency water, and storage.

BEDROOMS: There are four (4) client rooms: two (2) shared and two (2) private. All bedrooms were furnished appropriately; beds were observed with clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted.

RESTROOMS: There are six (6) total bathrooms in the facility; one (1) office bathroom, four (4) private client bathrooms, and one (1) shared common bathroom. At 10:43AM, LPA observed the toilet in client restroom in bedroom #2 to be in unsanitary condition. Staff stated that client refuses cleaning. LPA observed the other client restrooms in sanitary condition. Hot water temperatures were measured and were between 112.2-113.9 degrees Fahrenheit, which is within the required range. 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: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

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: PSYCLARITY HEALTH INC.	FACILITY NUMBER: 195850202
	VISIT DATE: 03/12/2026

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COMMON AREAS: The facility is a two-story home, consisting of an upstairs and a downstairs area. There are no common areas upstairs. Downstairs common areas include a living room, group room, and dining area. All furniture appeared clean and in good condition. LPA observed required postings throughout the common areas. LPA observed the fire extinguishers to be fully charged and last serviced on 06/17/2025. At 11:37AM, combination smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. LPA observed a locked laundry room.

TREATMENT/THERAPY & OFFICE AREAS: There is a group therapy room, one (1) clinical office and a staff office which is used to store medications. The Offices are kept inaccessible to clients unless properly supervised.

BACKYARD: The backyard had furniture and a covered patio area for client use. There is an in-ground pool which was locked and appropriately fenced at the time of the visit. The side gate was self-latching and in the case of an emergency everyone will use side door with automatic push button.

MEDICATION REVIEW: Beginning at 10:51AM, medications for two (2) clients were reviewed. Medications observed were properly labeled and medication records observed were documented per regulation, no errors observed.

RECORD REVIEW: Beginning at 11:41AM, LPA reviewed five (5) out of five (5) client and four (4) personnel files for documents including but not limited to: medical records, care plans, Admission Agreement, TB test, health screening, staff training and fingerprint clearance. Five (5) out of five (5) client files were missing TB test examinations. All personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted monthly, with the last drill conducted on 01/22/2026.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D).

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

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/12/2026 03:21 PM - It Cannot Be Edited

Created By: Angela Barutyan On 03/12/2026 at 02:38 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: PSYCLARITY HEALTH INC.	FACILITY NUMBER: 195850202
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

81069(f)(1)

Client Medical Assessments

(f) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/ infectious diseases. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as five (5) out of five (5) client files were missing TB examinations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/20/2026
	Plan of Correction
1 2 3 4	Management stated that all clients will complete TB tests and will submit proof. Management will also submit a signed statement of understanding of the section cited to CCL by the due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

LIC809 (FAS) - (06/04)

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