197610387-10-14-2025-31-AS-RCOR-DMFR8Q-20251014124819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610387
Report Date: 10/14/2025
Date Signed: 10/14/2025 12:48:32 PM

Document Has Been Signed on 10/14/2025 12:48 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:	MBI HEALTH SERVICES		FACILITY NUMBER:	197610387
ADMINISTRATOR/ DIRECTOR:	WODIN, PHYLLIS		FACILITY TYPE:	775
ADDRESS:	7231 SANTA MONICA BLVD		TELEPHONE:	(213) 946-0002
CITY:	WEST HOLLYWOOD	STATE: CA	ZIP CODE:	90046
CAPACITY: 60		CENSUS: 0	DATE:	10/14/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Phylis Wodin-Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/14/25, 10:00 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual visit to this facility. LPA met with Facility Administrator, Phyllis Wodin, and reason for the visit was disclosed. Facility is licensed as a two-story building. Fire clearance approved for a total capacity of sixty (60) ambulatory clients, none of which may be non-ambulatory. The facility maintains an approved Mitigation and Infection Control Plan. LPA spoke with the Administrator who stated the following: The Licensee has had difficulty contracting with area vendors. Administrator states the facility has not yet serviced any clients since approval of facility licensure (effective date: 5/21/24) At 10:30 am, LPA and the Administrator toured the facility and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main doors are the primary entry/exit access point, with four (4) emergency exits located from Upstairs stairwell, and first-floor Kitchen, Admissions/Client Intake, and Receptionist area. Screening area is located immediately upon entrance. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; thermostat displays a setting of 74.0°F. within the required range. Required postings, Personal Rights and Rights of Individuals with Developmental Disabilities are prominently displayed. [LIC 809-C] Continued-

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MBI HEALTH SERVICES	FACILITY NUMBER: 197610387
	VISIT DATE: 10/14/2025

NARRATIVE

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KITCHEN: LPA observed kitchen area to be clean and free of pests/vermin. Kitchen is equipped with appropriate fixtures. Lunch is not provided by program; however, snacks and drinks are provided. Refrigerator is available for clients who choose to store their own personal lunches. Kitchen pantry is stocked with sufficient supplies of disposable cups, plates and plastic eating utensils.

FIRE SAFETY: Fire detection system is present and in operation. Multiple dual smoke/carbon monoxide detectors are installed, hardwired, and interconnected throughout the facility. Four (4) fire extinguishers were observed in facility kitchen, admissions/intake, reception, and upstairs hallway. All extinguishers were serviced on 7/24/25. Evacuation routes are clearly labelled and posted.

BATHROOM: Bathrooms were checked for cleanliness, proper operation, and handicap accessible. Hot water temperature was measured at 116.0°F.; within regulations. No bodies of water located at this facility.

MEDICATION: LPA observed medications room located on first floor near near the client therapy rooms. Currently, there are no medications on facility premises. However, all client medications will be stored in locking cabinets or small meds refrigerator. First-aid kit is located on wall cabinet and appeared as fully stocked.

COMMONS: includes activity area, conference\media rooms, arts/craft area, therapy rooms, and Administrative/staff offices. Common areas observed to be clean, organized, and clear of obstruction. All rooms observed to be properly furnished and in good repair. Personal items storage is available to clients, if needed. Multiple working telephones observed.

STAFF RECORDS: LPA conducted a file review of Administrator's Staff records appear to be complete and updated.

There was no immediate health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

LIC809 (FAS) - (06/04)

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