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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850591
Report Date: 01/15/2025
Date Signed: 01/15/2025 05:35:33 PM

Document Has Been Signed on 01/15/2025 05:35 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:HIGHLANDS IN BLOOMFACILITY NUMBER:
195850591
ADMINISTRATOR/
DIRECTOR:		FARNELL, DEANNAFACILITY TYPE:
772
ADDRESS:28051 BALKINS DRIVETELEPHONE:
(805) 217-9500
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 6CENSUS: 0DATE:
01/15/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Deanna Farnell, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a pre-licensing inspection. The LPA met with Applicant/Administrator Deanna Farnell, Program Director Lisa Harris, and Marketing Director Rachel Farnell. Component II was completed on 12/18/2024.

The LPA toured the one-story home inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Required postings observed posted.

The fire clearance was granted on 09/26/2024; cleared for six (6) ambulatory clients only. Per fire inspection report (std850) clients are not permitted in the detached structure /garage located in the back on the property. Also the attached garage cannot be used for clients, office space, or staff use. Per fire inspection report, the attached garage is not permitted for any type of group or individual activity in the as it is non-habitable space. Garage is for vehicles and storage only. No flammables permitted in garage.

COMMON AREA: Open floor plan which includes the kitchen, dining area, and a living space area. The common areas were appropriately furnished, and the lighting was adequate. There is a fireplace in the living room which was properly screened. The facility smoke alarm system and the carbon monoxide detector was tested and were operable at the time of the visit. Fire extinguishers observed fully charged and inspected in 08/2024. There is an active telephone/line on the premises. Emergency exiting plans/sketch observed posted throughout the facility. Night lights observed in the hallway. Laundry detergent and cleaning supplies are stored inaccessible. THERAPY AND STAFF: Group therapy will take place in the open space area (family room) and individual therapy will take place in the designated office/therapy room located near the garage. Staff and client files will be stored in the attached garage. Facility will have awake staff only; there are no staff sleeping quarters on the property.

BEDROOMS/RESTROOMS: The facility has four (4) bedrooms and three in half (3.5) restrooms for clients use. There are two rooms for double occupancy and two rooms designated for single occupancy. Rooms were set up with beds, night stands, lamps, and closet space. Lighting in the rooms appeared adequate.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: HIGHLANDS IN BLOOM
FACILITY NUMBER: 195850591
VISIT DATE: 01/15/2025
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All restrooms were stocked with liquid hand soap and paper goods. Non-skid strips observed in the showers. The hot water measured in each bathroom is within 105 - 120 degrees Fahrenheit.

MEDICATIONS: Medications will be kept locked and inaccessible in the garage. First aid kits observed complete with manual.

GARAGE AND GROUNDS: The garage is accessible from the house and is kept locked. The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs where clients can sit. There is a gas fire pit located outside. There is a pool in the backyard and is fenced and locked. The facility plans to use personal vehicles for transportation.

INFECTION CONTROL: The facility will have a central entry point for symptom screening and sanitation station for staff, clients and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the licensee can obtain additional supplies as needed.


Component III was conducted with the applicant during today’s visit.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your 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 was conducted. Copy of the report provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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