197600306-3-19-2026-29-AS-CYEE-DSC4LJ-20260319191200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600306
Report Date: 03/19/2026
Date Signed: 03/19/2026 07:12:18 PM

Document Has Been Signed on 03/19/2026 07:12 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:	ACTIVITIES FOR RETARDED CHILDREN AND ADULTS		FACILITY NUMBER:	197600306
ADMINISTRATOR/ DIRECTOR:	CAROLE-ANN SCOTT		FACILITY TYPE:	775
ADDRESS:	6456 WHITSETT AVE.		TELEPHONE:	(818) 762-4365
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 36		CENSUS: 26	DATE:	03/19/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:37 AM
MET WITH:	Jennifer Pippard, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	07:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the entire CARE Inspection Tool and met with Jennifer Pippard, Executive Director. The reason for today's visit was explained. Also participating in today's visit was Jody Seal, Day Program Coordinator. The facility is a two storey building consisting of a large activity room(Great Room), living room, dining room, library(Tile Room), 2 bathroom and a kitchen on the first floor. The second floor consists of 3 offices, a computer room and 2 bathrooms. There is also a detached garage on the premises and is equipped as a gym. Located near the day program is a large swimming pool owned by the owners of the day program but has a separate address. The pool is secured by a ten (10) feet fence and the 2 gates to the pool area is padlocked. The facility is fire cleared for AMBULATORY clients only and is vendorized by the North Los Angeles County Regional Center. On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. Also reviewed were 5 Client and 5 Staff files, Emergency Disaster Preparedness Plan and the Infection Control Plan. A tour of the physical plant, inside and outside were toured. Clients were in attendance during today's visit. The following was observed: the living room is furnished with sofas, end tables and a activity table with chairs. Located in the living is a fire place that needs a fire screen the dining/art room is equipped with a dining room table and chairs for activities. continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

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: ACTIVITIES FOR RETARDED CHILDREN AND ADULTS	FACILITY NUMBER: 197600306
	VISIT DATE: 03/19/2026

NARRATIVE

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the kitchen has a refrigerator, a dishwasher, 2 microwaves and a stove. The kitchen is not used for preparing meals. The kitchen is used occasionally for cooking activities. Located in the kitchen are 2 tables and chairs for cooking and other activities. Canned food items were observed in the cupboards for clients who don't bring lunch. Dish soaps and detergents are stored in a locked cabinet under the sink. Cleaning solutions and knives are stored in the locked stairwell cupboard.
the large activity room, known as the Great Room is furnished with 36 chairs, folding tables and a large television.
the library/Tile room has a table with 4 chairs and books. The cupboards are used to store staff's personal belongings.
A first aid kit containing the tweezer, scissors, thermometer, gauze and ointments were observed in one of the cabinets in the Tile room with a first aid manual.
General Liability insurance for $1 million dollars per occurrence and $3 million annual aggregate was observed.
clients' belongings and coats are stored in closet by the front door.
2 bathrooms with a toilet and a sink are located by the kitchen. The water temperature tested in the front bathroom (left side) read 115.7 degrees Fahrenheit and the water temperature in the back bathroom (end of hallway) read 117.8 degrees Fahrenheit. The water temperature inside the upstairs back right office read 114.1 degrees and the bathroom located in the upstairs hallway read 125.7 degrees Fahrenheit.
A fire extinguisher was observed in the Tile Room, Kitchen and the upstairs hallway. They were last serviced on 8/25/25.
Oxygen in Use signs were observed on the front door, back door in the Tile Room and the kitchen doors.
Smoke detectors located downstairs in the large activity room, living room, dining room, by the 2 bathrooms and combination smoke/carbon monoxide detectors in the 4 upstairs office/rooms were each tested individually and were operational.
The front yard was observed with 8 tables, 32 chairs and 5 umbrellas for lunch and outside activities.
The backyard has a drive way, detached garage and is set up with 2 park benches. Located by the kitchen is an ADA approved ramp.

continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC809 (FAS) - (06/04)

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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: ACTIVITIES FOR RETARDED CHILDREN AND ADULTS	FACILITY NUMBER: 197600306
	VISIT DATE: 03/19/2026

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Page 3. The garage was observed with 3 stationary bikes and 4 tread mills. Overall, the inside and outside areas were observed to be clean. Deficiencies cited under California Code of Regulations, Title 22 Division 6, Chapter 3 Exit interview was conducted.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/19/2026 07:12 PM - It Cannot Be Edited

Created By: Christine Yee On 03/19/2026 at 06:37 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: ACTIVITIES FOR RETARDED CHILDREN AND ADULTS	FACILITY NUMBER: 197600306
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as the water temperature tested in the bathroom located in the upstairs hallway read 125.7 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/20/2026
	Plan of Correction
1 2 3 4	The Licensee will adjust the thermostat on the water tank to ensure that the water temperature is within Title 22 range of 105 - 120 degrees Fahrenheit. Provide evidence that the water temperature has been corrected by 3/20/26.

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:

	Christine Yee
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC809 (FAS) - (06/04)

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