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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606308
Report Date: 05/27/2025
Date Signed: 05/27/2025 01:39:08 PM

Document Has Been Signed on 05/27/2025 01:39 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:ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLSFACILITY NUMBER:
197606308
ADMINISTRATOR/
DIRECTOR:		MARGIE RHYNE, MICHAEL STEPFACILITY TYPE:
775
ADDRESS:7711 JELLICO AVENUETELEPHONE:
(818) 881-4427
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 14CENSUS: 10DATE:
05/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Michael Stephens, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 05/27/25, at 9:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Michael Stephens, Administrator.

LPA asked for the census, participant, and staff files.

The physical tour started at 11:45 am and LPA observed the following:

Common Areas: At approximately 11:45am, LPA and Administrator toured the facility. There is two (2) large activity rooms and a great room which is also used as an activity room next to the kitchen. LPA observed tables and chairs for the participants. All trash cans were observed to have lids. The facility maintains a temperature at 71 Fahrenheit.



The bathrooms: LPA observed two (2) bathrooms to be clean and have the wash your hands signs posted. One (1) of the bathrooms has a shower area that can be used for the participants. The other bathroom has a washer and dryer to wash the clothes used for cleaning. The bathroom that has a shower has grab bars. The hot water temperature tested in the bathroom is with in required range between 114.3 Fahrenheit. Trash cans in all bathrooms have lids.

There are two (2) fire extinguishers observed to be full and last serviced on 03/2025. One (1) is located by the great room and the other one (1) is located in the kitchen entrance on your right hand side.

809C-continued
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2025
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: ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLS
FACILITY NUMBER: 197606308
VISIT DATE: 05/27/2025
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Kitchen area: The First Aid kit and manual was observed to be complete. It is located in the kitchen area on your right hand side of the entrance by the refrigerators. There are two (2) refrigerators and one (1) Emergency Food Storage area. LPA observed the kitchen area to be adequately clean. The facility does not keep any food for participants. The participants bring their own breakfast/lunch/dinner. There are knives are kept in a metal cabinet on your left-hand side inaccessible and locked away from the participants.

Medications: There are no medications that are kept at this facility and there are no medications provided by the staff but there is a lock box in case any medications shall be brought by any participants. There is no AED-Automated External Defibrillator kept in the facility.

There are several exit doors. There is no transportation vehicles. The participants are taken out by public transportation out to the community. There are several smoke detectors and carbon monoxides through out the facility. There is no bodies of water.

Outdoor/Backyard: The facility has several structures addition to the main house. There is a garage area where additional tools and chemicals are stored. Facility has a shaded patio area for participants. An additional outdoor area is at the front of the facility. The facility is currently operating as a community based program. The community based program consist of participants being dropped off at the facility in the mornings between 7:00am and 8:00am.


Administration: The Infection control were reviewed and there was Covid 19 signs on the wall, hygiene sanitation signs, Emergency and Disaster Plan, Personal Rights, YES sign were observed in the great room on your right-hand side and the last fire drill was conducted May 2025. The insurance plan is up to date and expires 03/01/2026.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025
LIC809 (FAS) - (06/04)
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