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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608309
Report Date: 06/05/2025
Date Signed: 06/05/2025 06:20:39 PM

Document Has Been Signed on 06/05/2025 06:20 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:ETTA ISRAEL CENTER #4FACILITY NUMBER:
197608309
ADMINISTRATOR/
DIRECTOR:		HEIDI SCHOFIELDFACILITY TYPE:
735
ADDRESS:6101 BLUEBELLTELEPHONE:
(818) 980-1709
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 6DATE:
06/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:19 AM
MET WITH:Heidi Schofield, AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:25 PM
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Licensing Program Analyst(LPA) Christine Yee conducted and unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by staff. Giovanna Montano, House Manager and Heidi Scholfield, Administrator were contacted by staff and both arrived a little later to conduct the visit.. The reason for today's visit was provided.

The home is a single storey family home consisting of a front room, living room, dining room, family room, kitchen, 4 bedrooms, 2 full bathrooms and a detached garage. The home is fire cleared for 6 ambulatory clients only and is vendorized by the North Los Angeles County Regional Center.

On today's visit, LPA Yee reviewed all 12 domains of the CARE Inspection Tool, reviewed the training logs and conducted a tour of the entire facility, inside and outside.
  • The front room, dining room, living room and family room were all appropriately furnished for its designated use and sitting for 6 residents.
  • The fire place in the family was sealed off with plexiglass and a fire screen.
  • The kitchen is equipped with a stove, a refrigerator, a microwave and a dishwater.
  • Sufficient perishable for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed in the refrigerator, kitchen cupboards and in the garage.
  • The laundry room was observed with a washer and dryer.
  • A fire extinguisher was observed in the front room and laundry room. They were both last inspected on 10/2/24.
  • Bedroom #1, a shared room was furnished with 2 beds, 2 chairs, 2 lamps, a long dresser that was also being used as a night stand and a walk-in closet. Located inside the room is a private bathroom
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ETTA ISRAEL CENTER #4
FACILITY NUMBER: 197608309
VISIT DATE: 06/05/2025
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  • equipped with a walk-in shower, a toilet and a 2 sink vanity. Grab bars and a slip resistant mat were observed. The water temperature was tested and read 111.5 degrees Fahrenheit.
  • Bedroom #2 is also a shared room and furnished with 2 beds, 2 chairs, 2 lamps, 2 dressers and a closet. The appropriate bed linens were observed.
  • Bedroom #3 is a private room furnished with a single bed, a chair, a night stand, a dresser and the resident does not want a lamp or a door on the closet. Appropriate linens were observed.
  • Bedroom #4 is a private room furnished with a bed, a dresser, a desk with a chair, lamp and no night stand. A built in ledge is used in lieu of the night stand.
  • The common bathroom is equipped with a walk-in shower, a toilet and a 2 sink vanity. Grab bars, a slip resistant mat and a shower chair were observed. The water temperature was tested and read 113.2 degrees Fahrenheit. Hygiene products, toilet paper, paper towels were observed in the cupboards.
  • Towels were observed on a shelf in the common bathroom.
  • Extra blankets and bed linens were observed in the linen closet
  • Hygiene products and cleaning solutions and laundry detergent are stored in a locked closet by the front door.
  • Medications were centrally stored in a locked in a metal cabinet locked in the dining room.
  • The sharp knives are stored in a locked cabinet in the front room.
  • The first aid kit contains a tweezer, a pair of scissors, bandages, gauze, band aid and a thermometer. A first aid manual was also observed.
  • The detached garage located in the back and is primarily used for storage of non-perishable foods, diapers, water, wipes, toilet paper and paper towels.
  • The hard wired smoke detectors in all the resident rooms and the combination smoke/carbon monoxide detector in the hallway were tested and were operational. A separate carbon monoxide detector located in the family room was also tested and was operational.
  • the backyard was observed with a table, chairs and an umbrella for shade.
  • The trash cans along the left side of the home were observed to be tightly sealed.
  • Overall, the front and back yard were observed to be clean and well maintained.

No deficiencies were cited on today's visit.
Exit interview was conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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