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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610218
Report Date: 11/06/2025
Date Signed: 11/06/2025 01:17:18 PM

Document Has Been Signed on 11/06/2025 01:17 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALBARIDA ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197610218
ADMINISTRATOR/
DIRECTOR:		ALBARIDA, OSCARFACILITY TYPE:
735
ADDRESS:41853 YUMA COURTTELEPHONE:
(818) 572-5709
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 4DATE:
11/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Oscar AlbaridaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit on 11/04/2025 and was greeted by the Administrator, Oscar Albarida. LPA Spaeth stated the purpose of the visit was to conduct the annual inspection. The facility is licensed for four ambulatory clients and there are four clients. Upon arrival, LPA observed a client left to attend an adult day program and the Administrator confirmed the other three clients were attending another program.

LPA observed the client files and P&I at 8:50 am until 10:00 am. LPA Spaeth reviewed the staff files at 10:00 am until 10:20 am.

LPA and Administrator began the tour at 10:20 am until 10:55 am and observed the following:

Living Room/Dining Room Combination - LPA observed the living room and dining room are combined together. The living room section contained comfortable seating and the dining room contained a dining room table with chairs. LPA observed the residents’ medications were safely locked in the dining room closet. Additional PPE is also stored in a dining room cabinet.

Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALBARIDA ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197610218
VISIT DATE: 11/06/2025
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Kitchen - The knives were locked in a cabinet. There is a seven-day supply of non-perishable food and a two day supply of perishable food items. LPA observed the first aid kit was locked in a kitchen cabinet. LPA observed the fire extinguisher.

Family Room - LPA observed a large family room which contained comfortable seating and full screen projector for watching movies and television.

Bathrooms- LPA observed the bathrooms which contained hand soap, paper towels, and a trash can. The bathrooms were neat and clean.

Backyard – The backyard is shaded and contains comfortable seating. The pool is surrounded by a locked gate. The music room is located on the west side of the backyard property. .

Garage- A freezer is located in the garage.



Laundry Room - The room was locked and contained the washer/dryer and laundry detergent. Personal hygiene items are located in the laundry room.

Residents' Rooms - LPA observed three resident rooms contained night lamp, night stand, bed, linens, chair, and chest of drawers. The rooms were neat and clean.

Locked staff room was located on the second floor and was locked.

Carbon Monoxide/Smoke Detectors - The carbon monoxide/smoke detectors were tested at 10:45 am and were properly working.

Water Temperature - the water temperature 119 degrees F.

There are no deficiencies to report at this time. Exit interview was conducted and a copy of the signed report was given.
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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