<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602842
Report Date: 05/07/2025
Date Signed: 05/07/2025 04:23:31 PM

Document Has Been Signed on 05/07/2025 04:23 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:LIFE SKILLS TREATMENT PROGRAMFACILITY NUMBER:
197602842
ADMINISTRATOR/
DIRECTOR:		BROTMAN, ERICFACILITY TYPE:
775
ADDRESS:215 MACNEIL STREETTELEPHONE:
(818) 898-1926
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 40CENSUS: 27DATE:
05/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Alice Flores - Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:20 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) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit around 9:10am. LPAs met with Alice Flores Program Manager and explained the purpose of the visit. At around 9:45 am, LPA met with Eric Brotman-Program Director. The program is vendorized through the North Los Angeles Regional Center. The Adult Day Program is licensed for 40 ambulatory Developmentally Disabled Adults, ages 18 and above; seven (7) of whom may be non-ambulatory. There are 27 clients currently attending the program, seven (7) of whom are non-ambulatory. The program does not manage medication, but does provide snacks; the clients bring their own lunch to the day program.

LPA toured the facility with the Program Manager at 10:20 am and observed the following:

The facility is a two-story structure, owned by Saint Alphonsa Catholic Church. The church has a separate detached building, next to the day program. There is a shared parking lot for both buildings. There is a chapel on the first floor which is inaccessible to the day program. LPA observed a locked gate leading to second floor; the entire second floor is for church use only and is inaccessible to the day program. The day program building consists of a reception area, two offices, three storage rooms, two kitchens, 4 bathrooms (1 for staff and 3 for clients) and a shaded patio patio.

There is a central entry point located at the front, designated to screen all participants, staff, and visitors. There is the main entry door and a side exit, but the entry door is used as the main exit. The program site is clean, sanitary, and in good condition, all furnishings are in good repair with ample lighting. There are seven fire extinguishers throughout and all the fire extinguishers were charged on August 4, 2024.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2025
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 3
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)
Page: 2 of 3
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: LIFE SKILLS TREATMENT PROGRAM
FACILITY NUMBER: 197602842
VISIT DATE: 05/07/2025
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
Common areas: The facility is a Day Program. There is no backyard, no bodies of water was observed. Entry/exits were free of obstruction. There is a partially shaded patio, with ample seating. LPA observed room #4 (The Fellowship Room) and room #6 as activity classrooms. Facility sets up activity areas in the Fellowship Hall. Some activities include: Games, Retail Shop, Arts and Crafts, Seated yoga and zumba, music (piano, drums).

Kitchen: There are two kitchens, one for staff and one for clients. LPA observed an industrial stove, three refrigerators and a microwave in the main kitchen. The day program is not required to serve meals but LPA observed a small supply of perishable foods (2 days), since facility provides snacks to the clients.

Bathrooms: There are four bathrooms, one for staff, one for men, one for the women and one with wheelchair access usage. The men's bathroom has two (2) stalls and a urinal; women's bathroom has four (4) stalls. Hot water measured between 107.4 to 109.4 degrees Fahrenheit (F).

First-Aid Kit: There are five (5) complete first-aid kits on site with all required supplies and the first aid manual.

Cleaning supplies: All cleaning supplies are maintained in a locked storage room, inside room #4; inaccessible to clients.

Staff and Client files: All staff and client files were kept locked in the administrator's office. With the assistance of the Program Manager, LPA reviewed five staff and seven client files to ensure compliance of licensing forms. Staff files were reviewed to ensure that medical forms and training are up to date.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

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

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3