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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610376
Report Date: 04/09/2026
Date Signed: 04/09/2026 01:18:17 PM

Document Has Been Signed on 04/09/2026 01:18 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LIFESYNC MALIBUFACILITY NUMBER:
197610376
ADMINISTRATOR/
DIRECTOR:		EUNICE AVALOSFACILITY TYPE:
772
ADDRESS:6231 MURPHY WAYTELEPHONE:
(424) 235-2555
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 6CENSUS: 2DATE:
04/09/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Justin Helfert, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced case management visit at this facility to follow up on the incident occurred on 04/07/26 at 7:10pm, wherein Client #1 (C1) reported that he/she had been sexually assaulted while lying in his/her bed in her room. LPA met with Administrator, Executive Director, and Clinical Director and explained the reason for the visit.

LPA conducted a physical plant tour at 11:10 AM, requested copy of facility documents at 11:15 AM, reviewed records between 11:20 AM to 11:25 AM and interviewed the Executive Director between 11:30 to 12:00 PM. During interview, the Executive Director stated that C1 was admitted to the facility on 04/06/2026 from another facility. Since admission, C1 reportedly expressed a desire to leave the facility. LPA was informed that C1 met with multiple clinicians in an effort to identify the reasons for wanting to leave, and resources were offered to support C1. The Executive Director stated, “The facility was made aware of C1’s pattern of transferring through several facilities where C1 was admitted for only a couple of days and left without completing rehabilitation.”

Regarding the reported incident on 04/07/2026, facility staff reported that C1 disclosed being sexually assaulted; however, C1 did not provide identification of an alleged perpetrator, a specific time of occurrence, or additional details regarding the allegation. Shortly after making the allegation, C1 informed staff of his/her intent to leave the facility Against Medical Advice (AMA) and departed the facility prior to further assessment or follow-up. Facility staff contacted law enforcement regarding the allegation. Officers advised that an investigation could not be initiated at that time due to C1 no longer being present at the facility and the limited details available. Law enforcement further indicated that any additional investigation would require direct reporting from C1. Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2026
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIFESYNC MALIBU
FACILITY NUMBER: 197610376
VISIT DATE: 04/09/2026
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The facility has initiated an internal review of the incident under the direction of facility leadership, including evaluation of staff presence and review of available records. Staff statements have been collected and are being maintained as part of the investigation record.

Facility management stated they will continue to cooperate with law enforcement and regulatory agencies and will provide additional information if it becomes available. Based on today’s visit, LPA gathered information regarding the reported allegation, reviewed facility records, interviewed facility representatives, and documented the facility’s response to the incident, additional follow-up may be conducted as needed pending receipt of further information.

No deficiency issued during today’s visit

Exit interview conducted and copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC809 (FAS) - (06/04)
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