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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609885
Report Date: 04/01/2026
Date Signed: 04/01/2026 11:41:27 AM

Document Has Been Signed on 04/01/2026 11:41 AM - 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:EPHRATAH HOME 1FACILITY NUMBER:
197609885
ADMINISTRATOR/
DIRECTOR:		AHIABOR, FRANCESSFACILITY TYPE:
735
ADDRESS:4605 W. AVENUE J12TELEPHONE:
(818) 310-7602
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 4CENSUS: 4DATE:
04/01/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Alex Ahiabor - LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Evelin Rios arrived to the facility to conduct an unannounced required annual inspection. LPA met with Alex Ahiabor the Licensee who granted access. Alex contacted the administrator, Francess Ahiabor by telephone and LPA Rios explained the reason for the visit. This is an Adult Residential Facility (ARF) Level 2 with an approved fire clearance for 4 ambulatory clients. In the facility LPA observed one (1) staff and four (4) clients.

At approximately 8:50 AM, LPA initiated a physical plant tour of the facility inside and out and the following was observed.

Common Areas: These include the living rooms, dining area and loft space. LPA observed furniture in the common areas in good repair. Dining and living room furniture sits the capacity of the facility. LPA observed two (2) fire extinguishers, one located near the entry and the second in the kitchen. Both extinguishers were fully charged and had a service date of 08/26/2025. LPA also observed two (2) carbon monoxide detectors, one was by the kitchen and the other was in the second floor hallway. They were tested at 9:13 AM and found to be operational. At 9:15 AM, the licensee tested the hardwired, interconnected smoke detectors, and LPA observed them to be functioning properly.

Kitchen: LPA observed a freezer, a refrigerator, stove, microwave and dishwasher. LPA observed a seven day supply of non-perishable food and a two day supply of perishable foods. Repackaged food was stored securely in appropriate containers. LPA observed a locked closet by the kitchen. The facility stores all knives, sharps, the first aid kit, emergency food and water supplies, client medications, facility records and cleaning products in locked closet by the kitchen. (Continue to LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2026
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: EPHRATAH HOME 1
FACILITY NUMBER: 197609885
VISIT DATE: 04/01/2026
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Bedrooms: There are four (4) client bedrooms for single use. LPA observed bedrooms to be properly furnished with a bed, linens, night stand, chair, chest of drawers, closet, and adequate lighting. LPA did not observe any furniture in disrepair.

Bathroom: There are three (3) client bathrooms one (1) is located in a client's bedroom for private use. The bathrooms contained hand soap, paper towels, toilet paper and trash bins. Water temperature was taken in two (2) bathrooms. The temperature for the common bathrooms located downstairs and on the second floor measured between 119 and 120 degrees Fahrenheit, within regulation. LPA observed night lights leading to the bathrooms.

Laundry Room: LPA observed the laundry room on the second floor accessible to clients. The laundry room contains a washer and dryer. LPA observed a closet near the laundry room locked that contained an overflow of toiletries, detergent, paper towels, and cleaning chemicals.

Garage: The garage is attached to the facility and is accessible to clients. LPA did not observe any hazardous materials stored in the garage.

Backyard: LPA observed a patio area with shade for clients. No bodies of water observed.

Client, Staff and Facility Records: At approximately 10:00 AM LPA reviewed four (4) staff records to ensure compliance with licensing forms. LPA also reviewed facility records, such as the Emergency Disaster Plan (LIC610D), Personnel Record (LIC500), Surety Bond, and emergency disaster drills.


At 10:30 AM LPA reviewed four (4) of (4) client records to ensure compliance with licensing forms.

Medications: With the assistance of the licensee LPA reviewed centrally stored medication and medication records for proper documentation. Medication records are maintained manually. Facility maintains Medical Administration Records (MAR).

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during today's visit. Exit Interview was conducted and a copy of the report was provided to the Licensee.
NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
LIC809 (FAS) - (06/04)
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