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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850386
Report Date: 05/23/2025
Date Signed: 05/23/2025 04:10:58 PM

Document Has Been Signed on 05/23/2025 04:10 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ELEVATION BEHAVIORAL HEALTHFACILITY NUMBER:
195850386
ADMINISTRATOR/
DIRECTOR:		CHAD WILLIAMSFACILITY TYPE:
772
ADDRESS:5182 GARRETT CT.TELEPHONE:
(858) 695-4069
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY: 6CENSUS: 1DATE:
05/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Greg Allen, Human Resources DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an Annual Required visit. Upon arrival LPA met with staff and reason for the visit was explained. Greg Allen arrived shortly after to assist with the visit since the Program Director was unavailable to join.

A physical plant tour was conducted with Mr Allen and facility staff. Property is a two (2) story single family dwelling - five bedrooms and six restrooms; contains a detached garage and room above, which includes a restroom and kitchenette (used as office space only). COMMON AREAS: On the first floor, include the great room, dining room, breakfast nook, and laundry room. On the second floor, there is a theater room and a yoga room. The common areas were furnished to accommodate a maximum capacity of 6 (six) clients. There are several fireplaces throughout the facility in both common areas and bedroom space, which were all observed to be adequately. Cleaning supplies are stored in the locked garage. There were no immediate hazards observed. Fire extinguishers were observed throughout the facility; all were observed to be fully charged and last serviced on 02/07/2025; hardwired smoke detectors and separate carbon monoxide detector were tested and all were functional at the time of the visit. TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: There is a house staff office on the lower level, and the medication area/staff office located in the facility attached garage. There is also a group room, and sitting/group room on the second story. Medications are stored in a locked cabinet and locked refrigerator inside the ground floor locked garage. The first aid kit was observed to be complete. KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient emergency food and water supply to accommodate a maximum capacity of 6 clients for (seven) 7 days. There was sufficient dining and cook ware to accommodate a maximum capacity of 6 (six) clients. Knives and other sharps are stored in locked cabinet and inaccessible to clients in care. There were no visible immediate hazards observed. (Continue to LIC809c).

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2025
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELEVATION BEHAVIORAL HEALTH
FACILITY NUMBER: 195850386
VISIT DATE: 05/23/2025
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BEDROOMS: There are 5 (five) bedrooms, of which 4 (four) are designated for private resident use and 1 (one) is a shared room. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens, as well as emergency lighting. There were no visible hazards or discrepancies observed.

BATHROOMS: There are 6 (six) total bathrooms, 3 (three) on the ground floor and 3 (three) on the second story. 5 (five) restrooms are designated for private resident use and 1 (one) is designated as a staff bathroom. All Bathrooms were supplied with appropriate paper and hygiene products. Water temperature was measured in client bathrooms and measured at 127.8 degrees F; staff adjusted water temperature during visit. Hot water was tested during the visit measured within the required range of 105 degrees F to 120 degrees F at the time of the visit.

SURROUNDING GROUNDS: The front yard includes a driveway, walkways and landscaped areas, as well as a gazebo next to the detached garage and a sport court and batting cage behind the detached garage. There is a courtyard, with access from the dining room and staff office areas which contained outdoor seating. The backyard includes both paved and landscaped areas, a patio, furniture appropriate for outdoor use, shaded area, as well as an in-ground pool. The pool is kept inaccessible to clients with the use of fencing and a locked gate.

From approximately 11:45pm-12:45pm, LPA reviewed three (3) staff files for documents including but not limited to: TB test, health screening, staff training, First Aid and CPR training, and fingerprint clearance. All three (3) staff files reviewed were in compliance with regulation at the time of the visit. Client file reviewed for documents including but not limited to: Admission agreement, appraisal, needs and services plan, medical assessment, TB test results, consent forms, personal rights, and safeguards personal/valuables form. Client's medical assessment observed on file pending physician signature. Medication procedures and records reviewed at approximately 1pm.



INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility’s policies and procedures as it pertains to infection control are reviewed annual. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 2/23/2025.
Staff were reminded to provide a copy to the Department when changes are made.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC809 (FAS) - (06/04)
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