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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608461
Report Date: 03/20/2026
Date Signed: 03/20/2026 02:41:56 PM

Document Has Been Signed on 03/20/2026 02:41 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:EASTER SEALS SOUTHERN CALIFORNIA KENWOOD RESIDENCEFACILITY NUMBER:
197608461
ADMINISTRATOR/
DIRECTOR:		LOURDES MACATANGAYFACILITY TYPE:
735
ADDRESS:1930 KENWOOD STTELEPHONE:
(818) 512-2494
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 4CENSUS: 4DATE:
03/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Lourdes Macatangay - AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. LPA met with Administrator Lourdes Macatangay and explained the purpose of the visit. The program is vendorized through the Frank D. Lanterman Regional Center. The Adult Residential Facility (ARF) is licensed for 4 non-ambulatory adults. Current census is four (4) non-ambulatory residents. LPA utilized the CARE Inspection Tools during today's visit. LPA toured the facility with the Administrator at 9:10 am and observed the following:

Required postings were observed in the office area and by entry door. The front entry is the main exit door for emergencies. There are three (3) additional exits (by the kitchen, dining room/patio and hallway) leading to the backyard. In addition, all four bedrooms has exit doors. There are three (3) fire extinguishers, one (1) in the kitchen, one (1) in the hallway and one (1) in the laundry room. Both fire extinguishers in the kitchen and hallway had service dates of 02/20/2026 and the laundry room fire extinguisher was serviced on 02/09/2026. Facility conducts monthly fire drills and safety drills and quarterly earthquake drills. The last fire drill was conducted on 02/12/2026 and disaster/earthquake drill was conducted on 12/22/2025. The smoke alarms and carbon monoxide detectors are battery operated and are not interconnected. At 10:05 am the smoke/carbon monoxide alarms were tested in each room and observed to function properly.



Common Areas: Include a living room, dining room, family area and breakfast nook in the kitchen. The office area is located by the dining room. Living room is located by the entry door. A screened non-functional fireplace, a table and ample sitting were observed in the living room. Television set, karaoke machines and activities/games were observed in the family area. Dining room is furnished with a table and three benches.

Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2026
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: EASTER SEALS SOUTHERN CALIFORNIA KENWOOD RESIDENCE
FACILITY NUMBER: 197608461
VISIT DATE: 03/20/2026
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Kitchen: Appliances consisted of a refrigerator, stove, microwave and toaster oven. There is a breakfast nook with a table and chairs. Knives and sharp kitchen utensils are stored in a locked cabinet underneath the sink. There are two (2) electrical generators in the kitchen. LPA found a sufficient amount of perishable (2 days) and non-perishable food supplies (7 days), stored in cabinets and refrigerator. All food supplies were marked with the purchase dates. Food storage and preparation areas and kitchen cabinets are maintained in clean and sanitary condition. Kitchen has an exit door, leading outside.

Laundry Room: The laundry room is located next to the dining area and had a washer and dryer. All laundry detergents/chemicals are stored in a locked cabinet and there was a separate storage for emergency food supplies. The laundry room has an exit door, leading outside.



Bedrooms: There are four (4) private bedrooms designated for clients' use. All of the bedrooms were properly furnished with appropriate chairs, beddings. television sets, linens with sufficient lighting. All bedrooms have exit doors leading outside to the backyard.

Bathrooms: There are two (2) bathrooms designated for residents’ use and one (1) half bathroom for staff use. All toilets and sinks are maintained in sanitary and in operating condition. LPA observed proper grab bars, non-skid mats and covered trash cans in the bathrooms. Hot water temperature was measured at 113.0 and 118.2 degrees Fahrenheit, within regulation

Surrounding grounds: Entry/exit gates and pathways were free of obstruction. No bodies of water were observed at the facility. There is ample patio space for outdoor activities. There was a covered patio area with furniture appropriate for outdoor use, sufficient for number of residents. Facility's garage is detached and is currently used as storage and is kept locked. LPA observed one (1) refrigerator for staff use and cabinets with supplies of incontinence and other supplies.

First-Aid Kit/Medications: All medications were observed to be locked in a kitchen cabinet. LPA observed two (2) complete first-aid kits with all required supplies and the first aid manual and another kit in the laundry room, with the emergency supplies. Medications records for all four (4) residents were counted and verified for accuracy of administration, based on physician orders.

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NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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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: EASTER SEALS SOUTHERN CALIFORNIA KENWOOD RESIDENCE
FACILITY NUMBER: 197608461
VISIT DATE: 03/20/2026
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Resident Files: All resident records were observed to be locked in the office. A review of four (4) resident records to ensure compliance of licensing forms was conducted. P&I was also counted for all four (4) residents.

Staff Files: Records for five (5) staff members were reviewed to ensure all forms and training and first aid certificates are up to date.

Required documents: Administrator Certificate was observed with expiration date of 08/04/2027. Liability insurance has expiration date of 12/06/2026 and surety bond has expiration date of 10/24/2026. Facility has a van, with automobile insurance expiration date of 07/01/2026.

Facility has cameras installed (only pictures) in the front and back of the house. Facility has a land line telephone, wi-fi access and cable for residents' use.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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