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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850584
Report Date: 04/29/2026
Date Signed: 04/30/2026 07:38:26 AM

Document Has Been Signed on 04/30/2026 07:38 AM - 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: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: 5DATE:
04/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Paul FigueroaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 11:00 A.M. At 11:30 A.M. LPA met with Program Director, Paul Figueroa and Shift Supervisor, Jennifer Benavides. Entrance interview conducted.

This facility is a two-story home. Beginning at 12:05 P.M., the LPA, along with the Program Director and Shift Supervisor, toured the physical plant areas inside and out. The facility does not maintain a surety bond, as the facility does not handle or retain residents’ cash funds. The following was observed.

First Floor:

BEDROOMS: There are three (3) bedrooms for shared-use. LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The bedrooms were large enough to allow for easy passage between the beds and furniture. Inside temperature was maintained at a comfortable level. There is no staff bedroom on premises – ‘awake night staff required’.

RESTROOMS: There is one (1) bathroom in the hallway for client use between Room #1 and Room #2. Room #3 has a shared bathroom in room. Client restrooms were clean, sanitary, and in operating condition with slip-resistant materials. Between 12:20 P.M. and 12:50 P.M., the hot water temperature was tested and was found to be within the range of 105 -120 degrees Fahrenheit.

KITCHEN: LPA toured the kitchen. Kitchen appliances were clean and in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and sharps were stored locked and inaccessible in multiple drawers next to the kitchen sink.

Continued from LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2026
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: OPI STR - CAMPO
FACILITY NUMBER: 195850584
VISIT DATE: 04/29/2026
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Continued from LIC 809

COMMON AREAS: Common areas including a living room, family room, and dining area were furnished appropriately. Activities for clients were available. All furniture appeared clean and in good condition. LPA observed required postings throughout the common areas. At 2:12 P.M., combination smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. A working phone designated for facility use was observed. A locked room next to the main entrance was observed to contain client’s hygiene supplies and sharps. LPA observed cameras on the outside perimeter of the house and backyard and fire extinguisher throughout the house that were last serviced within 12 months.

GARAGE/STAFF OFFICE: A staff office, staff bathroom and garage are located on the ground floor. Staff office contained a desk and cleaning supplies. Garage was observed locked during visit; cleaning solutions, emergency food and water, extra hygiene supplies, emergency items and PPE supplies are stored in the garage.

SURROUNDING GROUNDS: The exterior passageways leading to the two (2) side gates were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs for client use. 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 that were locked and fenced off, and inaccessible to clients. Two in-ground fountains were observed in the front yard near the facility front door.

Second Floor:

TREATMENT/THERAPY/OFFICE AREAS: Rooms consisted of various office spaces and therapy rooms for (group/private) sessions. They were observed to remain locked, and only accessible to clients with staff supervision. There are three restrooms which were clean and operable; hot temperature tested within the range of 105-120 degrees Fahrenheit. Additionally, there is a kitchenette where hot water temperature was within regulation range, a nurse’s office where the medication is kept locked and the emergency kit and supplies are located.


Continued from LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: OPI STR - CAMPO
FACILITY NUMBER: 195850584
VISIT DATE: 04/29/2026
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Continued from LIC 809-C

LAUNDRY ROOM: A locked laundry room was observed containing laundry supplies and extra linens. The laundry room is kept inaccessible to clients unless properly supervised.

MEDICATION ROOM: Nurse/staff office, which contained a locked medication closet was observed. Medications are centrally stored in the medication room.

MEDICATION REVIEW: At 2:45 P.M., medications were reviewed for two (2) clients. Medications observed were properly labeled and medication records observed were documented per regulation, no errors observed.

RECORD REVIEW: Client and staff records are stored electronically. Beginning at 12:40 P.M., LPA reviewed five (5) out of five (5) clients and six (6) personnel files including Program Director. LPA reviewed documents including but not limited to: medical records, care plans, Needs and Service Plan (Master Treatment Plan), Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All client and personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: 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 04/20/2026.

During today’s visit LPA obtained a copy of the facility’s Personnel report (LIC 500), client roster, and Emergency and Infection Control Plan. LPA provided a copy of the license printed on 05/16/2025 to the Program Director during today’s visit.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC809 (FAS) - (06/04)
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