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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608661
Report Date: 05/28/2026
Date Signed: 05/28/2026 04:29:12 PM

Document Has Been Signed on 05/28/2026 04:29 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:ELWYN NC - KELVIN 1FACILITY NUMBER:
197608661
ADMINISTRATOR/
DIRECTOR:		CRYSTAL CORTESFACILITY TYPE:
735
ADDRESS:5651 KELVIN AVETELEPHONE:
(747) 900-6742
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 4CENSUS: 4DATE:
05/28/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:42 AM
MET WITH:Arthur TuhumwireTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:42AM. LPA met with staff. Lead Direct Support Professional Arthur Tuhumwire arrived at 02:55PM. Administrator Crystal Cortes was unable to be present for the visit. Entrance interview conducted.

Beginning at 10:52AM, the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed.

BEDROOMS: The facility is a single-story residential home with four (4) bedrooms for private-use. LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There is no staff bedroom on premises. All bedrooms have exits to the exterior and were equipped with functional auditory exit alarms.

RESTROOMS: The facility has two (2) restrooms; one (1) by client bedrooms and one (1) by the office. Restrooms were clean and sanitary and in operating condition with slip-resistant materials and grab bars. Hot water in client restroom measured at 105.1 degrees F, which is within the required range.

KITCHEN: LPA toured the kitchen at 10:58AM. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Knives and cleaning solutions were stored locked and inaccessible in a kitchen drawer and under-the-sink cabinet. There were no pesticides or toxins stored in any food storage area or preparation area with utensils. The facility had an emergency water and food supply.

Report Continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2026
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
VISIT DATE: 05/28/2026
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COMMON AREAS: LPA observed common areas to be clean and properly furnished. Fire extinguishers were fully charged and last serviced on 02/12/2026. LPA observed required postings in common areas. Security cameras were observed around the outside perimeter of the facility. Inside temperature was maintained at a comfortable level. All exits had functioning auditory exit alarms. LPA observed hallway closets containing additional supplies, extra linens, and client belongings. At 11:08AM, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit.

OUTDOOR SPACE: LPA observed the back patio which has a covered outdoor area for client use. Passageways were free and clear from obstruction. There were no bodies of water on the premises. Exit gates were observed to self-latch.

OFFICE/LAUNDRY: LPA observed the office area by the kitchen which contained an additional refrigerator and freezer, washer and dryer, locked laundry detergents, and additional supplies. Medication and file cabinets were kept locked and inaccessible.

MEDICATION REVIEW: At 02:57PM, LPA reviewed medications for two (2) clients. Medications were centrally stored and locked in a cabinet in the office. All medications were labeled, stored, and locked inaccessible to clients. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications were properly documented. No errors observed during the medication review.

RECORD REVIEW: Beginning at 03:30PM, LPA reviewed four (4) out of four (4) client and four (4) personnel files for documents including but not limited to: cash resources, medical records, care plans, Admission Agreement, TB test, health screening, first aid/CPR training and fingerprint clearance. All client and personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted monthly, with the last drill conducted on 05/13/2026.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
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