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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601489
Report Date: 07/16/2026
Date Signed: 07/16/2026 04:32:17 PM

Document Has Been Signed on 07/16/2026 04:32 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:CARRIE'S BOARD AND CAREFACILITY NUMBER:
197601489
ADMINISTRATOR/
DIRECTOR:		CARRIE ACOSTAFACILITY TYPE:
740
ADDRESS:8430 COLBATH AVENUETELEPHONE:
(818) 893-7619
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 6CENSUS: 4DATE:
07/16/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:14 PM
MET WITH:Carrie AcostaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 02:22 PM to conduct a case management - deficiencies visit at the facility. LPA met with facility staff who contacted the Administrator Carrie Acosta. The Administrator arrived to the facility at 02:26 PM. Entrance interview was conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a physical plant tour and interviewed one (1) resident between approximately 02:30 PM and 04:15 PM.

During the physical plant tour LPA observed two (2) emergency exit doors attached to resident bedrooms #3&4 to be barricaded shut from the outdoors. LPA observed two (2) metal bedframes, a garden hose reel, and a rope positioned outside of the emergency exit doors which blocked the emergency exit. LPA observed the two metal bed frames to be positioned at an approximately 60 degree angle with the edge of the bedframe positioned under the door handle in such a way that the door appeared to be deliberately blockaded from the outdoors of the facility. LPA asked the Administrator why the doors appeared to be barricaded. The Administrator stated that they had a previous resident who exhibited exit seeking behaviors and often attempted to leave the facility. The Administrator stated that facility staff may have placed the items in that way to prevent the resident from utilizing the emergency exit doors as a way to leave the facility without staff knowing. The Administrator stated that that resident no longer resided at the facility. LPA notified the Administrator that under no circumstances should the exit doors to the resident bedrooms be barricaded to prevent resident egress and having done so constituted a violation of the facility’s fire clearance. The Administrator had the barricades removed from the doors at the time of the visit. LPA notified the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (07/16/2026) for a violation of health and safety code (HSC) section 1569.149. CONTINUED ON LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2026
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 4
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: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
VISIT DATE: 07/16/2026
NARRATIVE
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During the visit LPA observed the facility Administrator instructing facility staff to wake up Resident #1 (R1) from their sleep and to bring R1 to the dining table using their walker to prepare them for dinner. LPA observed facility staff informing the Administrator that R1 was sleepy but the Administrator insisted that R1 be woken up and brought to the table using their walker. LPA observed staff members walking R1 to the dining table using their walker. R1 was slumped over the walker and appeared unstable on their feet and tired. Upon observing the resident LPA notified the Administrator who immediately instructed staff to transfer R1 to their wheelchair for the safety of the resident. LPA asked the Administrator why facility staff would attempt to ambulate R1 through the facility in an unsafe manner when R1 appeared too tired to support their own weight. The Administrator stated that facility staff were just following their instructions but should have made a better judgement call for which device was appropriate to assist R1 in ambulation. LPA asked facility staff why they thought it was appropriate to assist R1 in the unsafe manner. Facility staff responded that this was because their boss told them to do it that way. LPA informed staff that they need to communicate their concerns with the Administrator if given instructions would place a resident into harms way. LPA reminded the Administrator and facility staff that the facility is responsible for providing care and supervision appropriate to the resident's needs.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty was assessed (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/16/2026 04:32 PM - It Cannot Be Edited


Created By: Trevor Byrne On 07/16/2026 at 03:28 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: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2026
Section Cited
HSC
1569.149

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§1569.149 Fire clearance...
... the facility shall secure and maintain a fire clearance...
This requirement is not met as evidenced by:
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Administrator had the barricades removed at the time of the visit. Administrator agreed to conduct an in-service training with all facility staff on the importance of ensuring all emergency exit ways remain clear and free from obstruction. Additionally, the Administrator agreed to conduct training on...
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Based on observation the licensee did not comply with the section cited above as two facility emergency exit doors attached to bedrooms #3&4 were deliberately blockaded from the outside of the facility which posed an immediate safety risk to clients in care.
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...appropriate staff responses to resident's with wandering behaviors, redirection techniques, and emergency notification procedures for resident elopement. Administrator agreed to submit proof of the completed trainings to CCLD no later than POC due date.
Type A
07/17/2026
Section Cited
CCR87464(f)(1)

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87464 Basic Services
(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement is not met as evidenced by:
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Administrator agreed to conduct an in-service training with staff members on appropriate assistance techniques and devices when assisting residents with ambulation through the facility. Additionally, Administrator agreed to train facility staff about voicing safety concerns and modifying instructions to...
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Based on observation the licensee did not comply with the section cited above as three staff members followed the Administrator's instructions and utilized an ambulatory aid inappropriate to the resident's current condition which posed an immediate safety concern to clients in care.
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...better care for the residents and to ensure no resident is placed in harm's way due to following instructions as given. Administrator agreed to submit proof of the completed trainings to CCLD no later than POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2026


LIC809 (FAS) - (06/04)
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