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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606257
Report Date: 06/04/2025
Date Signed: 06/04/2025 01:56:08 PM

Document Has Been Signed on 06/04/2025 01:56 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:EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSEFACILITY NUMBER:
197606257
ADMINISTRATOR/
DIRECTOR:		LISA MARIE MCDONALDFACILITY TYPE:
735
ADDRESS:7306 PASO ROBLES AVETELEPHONE:
(818) 609-8227
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 3CENSUS: 0DATE:
06/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:49 AM
MET WITH:Barbara PachecoTIME VISIT/
INSPECTION COMPLETED:
02:12 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility to conduct an annual required inspection. LPA arrived at the facility and rang the bell and knocked several times and there was no answer. LPA contacted the Administrator via telephone call and left voice mail. The Administrator Danny Tapia called back shortly thereafter. The Administrator was under the impression that the facility had surrendered the facility license, but after clarifying with the Licensee, it was determined that the facility license will not be surrendered at this time. Per the Administrator, the facility’s last client left in December of 2024, and was relocated by the North Los Angeles County Regional Center to another facility. The facility has been vacant since December of 2024. The Licensee is waiting for referrals from the North Los Angeles County Regional Center, unknown date of potential clients being referred. The Administrator was not near the vicinity of the facility, consequently the Administrator asked Barbara Pacheco, Residential Administrator to assist with the annual inspection.

The LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and were last serviced 04/07/2025. The LPA observed required postings in the kitchen area.

Continues on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025
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)
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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: EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE
FACILITY NUMBER: 197606257
VISIT DATE: 06/04/2025
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KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. At the time of the visit, the facility did not have clients. The last client left and was relocated by the NLACRC to another facility in December of 2024. Consequently, the facility did not have any perishable and non-perishable food. The Administrator was advised to inform the CCL Department prior to admitting clients, so that a case management visit-other is conducted to ensure that the facility is ready to accept new clients. Sharp objects are stored in a locked cabinet next the washer and dryer. Medications and first aid kit are kept in a locked cabinet. Washer and dryer are located in the kitchen area. Cleaning supplies are located in a locked cabinet.
BEDROOMS: There are three residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: There are three bathrooms. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hallway bathroom next to bedroom #2 was observed to have a bathtub with peeling paint. Administrator was advised to have the bathtub fixed prior to admitting clients. The private bathroom located inside bedroom #2, was observed to have grout with rough edges and cracked tile, which will require repair before admitting clients.

OUTDOOR AREA: The backyard has two covered outdoor areas equipped with furniture for client use. The right-hand side area is located on concrete patch and had a patio table, chairs and patio umbrella. The left-hand side area has wood gazebo and wood flooring. The wood floor is rotted with holes and exposed nails. The Administrator stated that the area will be either replaced or removed prior to admitting new clients. There is one side gate for client use and is single latched. No bodies of water noted.

RECORDS: The facility did not have clients or staff at the time of the inspection.

MEDICATIONS: The facility did not have clients at the time of the inspection.

The LPA reviewed the following documents:


- LIC500 Personnel Report
- Surety Bond
- Certificate of Liability of Insurance

No citations were issued at this time. Exit interview conducted. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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