197606348-1-13-2026-31-AS-LNCA-DQAVDN-20260113152058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606348
Report Date: 01/13/2026
Date Signed: 01/13/2026 03:21:33 PM

Document Has Been Signed on 01/13/2026 03:21 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:	COMMUNITY INTEGRATION ADC		FACILITY NUMBER:	197606348
ADMINISTRATOR/ DIRECTOR:	PETER MEDVEDEV		FACILITY TYPE:	775
ADDRESS:	10100 BALBOA BL.		TELEPHONE:	(818) 772-1155
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 120		CENSUS: 73	DATE:	01/13/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Robert Erio- Program Director		TIME VISIT/ INSPECTION COMPLETED:	01:30 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) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with front desk Marlene Llanos and advised for the purpose of the visit. LPA met with Program director Robert Erio. At 9:30 AM, with the assistance of program director, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational and their carbon monoxide detectors are installed. There are three (3) fire extinguisher located within the facility and they are located: outside the kitchen (end of hallway), outside storage (beside staircase), and edge of common area, where the charge date is 10.9.2025. During the visit the facility is at 74 degrees Fahrenheit. Facility is licensed to serve adult and elderly individuals in less than 24 hour care. The facility is two (2) story building, the first (1st) floor is where the offices are located and common area where attendees do their program. The second (2nd) floor is inaccessible and lock to attendees and is kept only for storage and old equipment. The kitchen appliances and fixtures were functional. The kitchen has a working faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Continue to LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Leslie Ngo-Castaneda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026

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: COMMUNITY INTEGRATION ADC	FACILITY NUMBER: 197606348
	VISIT DATE: 01/13/2026

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There are two (2) bathrooms designated for attendees to use. Bathroom #1 is located close to the entrance where attendees can used and is separated from males and females. Bathrooms were properly supplied and had functional fixtures. Bathroom #2 is only for staff use and is located beside the staircase, which is lock and inaccessible to clients. Common bathroom hot water temperature was measured at 107.9 degrees Fahrenheit. Cleaning supplies are being stored in a locked cabinet under the staircase.
The common areas were properly furnished with lots of tables and chairs to do activities such as: karaoke, arts and crafts, jewelry making, movies, circuit training, and exercises. Computer/ internet are also available for use in the common area. Dining table are adequate to accommodate all of the attendees. Office space is located at the edge of the facility located at the right side of the facility upon entrance, where staff and attendees records are kept. No medications are stored in the facility or office area. First-aid has all proper items and is current.

Entry and exits were free of obstruction. LPA conducted a file review of resident records to ensure compliance of licensing forms. LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Leslie Ngo-Castaneda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026

LIC809 (FAS) - (06/04)

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