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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850584
Report Date: 04/02/2025
Date Signed: 04/02/2025 12:36:40 PM

Document Has Been Signed on 04/02/2025 12:36 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:OPI STR - CAMPOFACILITY NUMBER:
195850584
ADMINISTRATOR/
DIRECTOR:		BRETON, JESSICAFACILITY TYPE:
772
ADDRESS:5052 CAMPO RDTELEPHONE:
(818) 610-3956
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY: 6CENSUS: 0DATE:
04/02/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Jessica Breton, Pau Figueroa and
Janet Hamm-Tuverson		TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted a pre-licensing visit to the above noted facility. The LPA met with applicants, Jessica Breton, Paul Figueroa and Janet Hamm-Tuverson. This is a new facility. The facility is a two-story home. At 10 a.m., a physical plant tour was conducted inside and out. Fire clearance was approved 12/20/2024 for six (6) ambulatory clients only.
First Floor: The facility has three (3) bedrooms, all of which are shared. All client rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box comfortable mattress; includes, linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture. There are no staff rooms – ‘awake night staff required’. All rooms were free of odors. All window screens were clean and maintained in good repair. There is one (1) bathroom in the hallway for client use (Room #1 and Room #2). Room #3 has a shared bathroom in room. The client bathrooms have a shower with non-skid materials. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Kitchen area observed clean with operable appliances available for use. Fire extinguisher observed in the kitchen with service tag dated 10/3/2024. Common areas were furnished appropriately for clients use; activities available for clients use. Garage is accessible from the inside of the home; observed locked during visit; hygiene supplies, emergency food, water and PPE supplies are stored in the garage. Smoke/Carbon monoxide detector tested/operable. Active/working phone designated for facility use. Second Floor: Consisted of various office spaces and two therapy rooms for (group/private) sessions. There are three restrooms upstairs which were clean and operable; hot temperature tested within the range of 105.F and 120.F. Client and staff records will be stored in the locked office; medications will be centrally stored in the medication room/therapist station. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. (Continue to LIC809c)
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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: OPI STR - CAMPO
FACILITY NUMBER: 195850584
VISIT DATE: 04/02/2025
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Exterior:

The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where clients can sit. The entire property is gated. The back and sides of the house are separated from the front yard by a gate. There is a pool and jacuzzi on the premises which were observed inaccessible. Two accessible in ground fountains observed in the front yard near the facility front door. Administrators were informed that the fountains should be made inaccessible. Administrators agreed to make the fountains inaccessible and submit a photo for clearance. Administrator also agreed to ensure that a land line phone is activate and telephone number is provided. Submit facility telephone number once activated. Upon receipt of the corrections LPA will forward the prelicensing report to the CAB analyst.

Applicant will be notified by the CAB Analyst when license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted and copy of report provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
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