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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609591
Report Date: 04/15/2026
Date Signed: 04/15/2026 01:21:37 PM

Document Has Been Signed on 04/15/2026 01:21 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:T R E HOME IFACILITY NUMBER:
197609591
ADMINISTRATOR/
DIRECTOR:		JAMES CALHOUNFACILITY TYPE:
735
ADDRESS:1315 NORTON AVENUETELEPHONE:
(310) 863-4952
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 5CENSUS: 4DATE:
04/15/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:James Calhoun, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 04/15/26, at 09:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. James Calhoun, Administrator was advised of the visit.

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

The facility has been licensed as a Adult Residential Facility. There are currently four (4) clients that reside at the facility. The physical plant was toured inside and outside. It is a single, story home with a back house.

Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There is one (1) refrigerator in the kitchen area in the main house. There are two (2) refrigerators in the back house. The cabinets have canned goods. There are two (2) fire extinguishers fully charged and dated 12/2025.

The medication is kept by the kitchen area locked and secured in a black cabinet area locked and inaccessible to the clients.

LIC 809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2026
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: T R E HOME I
FACILITY NUMBER: 197609591
VISIT DATE: 04/15/2026
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Living Room and Dining Room: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The dining room area has several seating for the clients and a large television against the wall. There is a large table for clients to eat and a fire place that has a covering. The facility temperature is at 68 degrees Fahrenheit. Sharps/Knives and chemicals are kept secured and locked at the entrance of the house on your right hand side.

No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were tested and operational. They are hardwired.

Bedrooms: Facility has five (5) bedrooms and were toured. The bedrooms are fully furnished with proper lighting and bedding. Four (4) of the bedrooms are single occupied and one (1) is vacant.

Bathrooms: There are four (4) full bathrooms. The bathrooms contained a trash can with tight-fitting lid. Three (3) of the bathrooms are in the hallways. One (1) bathroom is private. Hot water was tested and measured 117.1 within regulations.

Outside/Backyard: The outside/backyard has furniture for clients to have proper seating. The facility has no signal system. There is a pool that is locked and inaccessible to the clients with no water in it. There are two (2) garages detached from the facility. There is one (1) washer and dryer in one (1) of the garages.

Administrative: The administrative Certification is current and expires 05/13/2026. There is no liability insurance, licensee was called and stated, "they will send it later." Personal Rights, Administrative Certificate and Facility Sketch is against the wall of the facility.

Staff/Client Files: Five (5) staff files were reviewed and four (4) clients files were reviewed. The P&I-Personal and Incidental funds were also reviewed. The last fire drill was on 04/2026.

An exit interview was conducted, citation(s) was issued for liability insurance, appeals right provided 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: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2026 01:21 PM - It Cannot Be Edited


Created By: Gina Saucedo On 04/15/2026 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: T R E HOME I
FACILITY NUMBER: 197609591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.605


This requirement is not met as evidenced by:On and after July 1, 2015, all...facilities...except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.
Deficient Practice Statement
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Based on the record review the licensee did not comply with the section cited above in the facility did not have proof of liability insurance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/29/2026
Plan of Correction
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Licensee is to send proof of insurance to LPA by POC date: 04/29/26.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Troy Agard
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2026


LIC809 (FAS) - (06/04)
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