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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601249
Report Date: 05/08/2025
Date Signed: 05/08/2025 02:50:31 PM

Document Has Been Signed on 05/08/2025 02:50 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INCFACILITY NUMBER:
197601249
ADMINISTRATOR/
DIRECTOR:		ROBERT MARTINEZFACILITY TYPE:
775
ADDRESS:204 N. VICTORY BLVD.TELEPHONE:
(818) 842-4933
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY: 30CENSUS: 15DATE:
05/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sheri Glendenning - Program DirctorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met with Program Director - Sheri Glendenning and explained the reason for the visit. The program is vendorized through the Frank D. Lanterman Regional Center. The adult day program is licensed for 30 non-ambulatory developmentally disabled adults, ages 18 and above. There are 15 clients currently in attendance. Programs run from 8:00 am through 2:30 pm. The program does not manage medication and does not provide meals; the clients bring their own lunch to the day program.

At approximately 09:40 am, with the assistance of the Program Director, LPA took a tour of the physical plant. The following were observed:

Required postings were observed in the kitchen and outside of the office. LPA observed a reception area in front of the entry door, designated to screen all participants and visitors. There is also an office, locked storage room, locker area for clients' personal storage, kitchen, 2 bathrooms for staff and for clients, and multiple activity rooms (music room, art and craft room, client relaxation room). Overall program site is clean, sanitary, all furnishings are in good repair. LPA observed two holes in the door of the larger bathroom and holes on the wall next to the bathroom. A citation will be issued to patch and repair the holes.

There are three fire extinguishers, one in the kitchen, one in the hallway and one in the front reception area. All the fire extinguishers were charged on 09/24/2024. Smoke detectors and the carbon-monoxide detectors are not interconnected and they were located throughout the building. The smoke detectors and the carbon monoxide detectors were tested at 12:30pm and were observed to be functional. Facility conducts emergency fire and earthquake drills. The last earthquake drill was conducted on 04/14/2025 and the fire drill was conducted on 04/30/2025.


Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 197601249
VISIT DATE: 05/08/2025
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Kitchen: There is a refrigerator, two microwaves and an oven toaster in the kitchen. There is no stove, no sharp knives, cutlery, as facility does not provide meals. LPA observed a small amount of non-perishable food supply (7 days), in addition there is a supply of emergency food and water in the kitchen.

Bathrooms: There are two (2) bathrooms for staff and clients. One of the bathrooms was larger and had a changing station and a hoyer-lyft. All toilets and sinks are maintained in sanitary, operating condition. Hot water temperature was tested between 117 - 119.1 degrees Fahrenheit. LPA observed two holes in the door of the larger bathroom and holes on the wall next to the bathroom. A citation will be issued to patch and repair the holes.

Storage room: All the cleaning solutions are locked in a storage room, across from the kitchen.

First-Aid Kit: There are two first-aid kits on site with all required supplies and with the first aid manual.
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Surrounding grounds: The emergency exit door is in the back, leading to the parking lot. There is no patio, yard or body of water. Entry/exits were free of obstruction. The outdoor area was free of hazards.

Resident/Staff Files: LPAs conducted a file review of resident records to ensure compliance of licensing forms. Staff files were reviewed to ensure medical forms and training are up to date.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, type B violation was observed during the visit and citation was issued..

Exit Interview Conducted / A Copy of the Report provided.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/08/2025 02:50 PM - It Cannot Be Edited


Created By: Nadia Shahbazian On 05/08/2025 at 02:16 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 197601249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The large bathroom with the changing station had two holes in the door, also the wall adjacent to the bathroom had several holes/damages; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/06/2025
Plan of Correction
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Facility will patch and repair the damages on the wall and on the bathroom door and will send pictures to LPA within 30 days.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Eva Miller
NAME OF LICENSING PROGRAM MANAGER:
Nadia Shahbazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2025


LIC809 (FAS) - (06/04)
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