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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610449
Report Date: 11/20/2025
Date Signed: 11/20/2025 04:01:41 PM

Document Has Been Signed on 11/20/2025 04:01 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:EXCELLENCE COMMUNITY RESIDENTIAL PROPERTIES 2FACILITY NUMBER:
197610449
ADMINISTRATOR/
DIRECTOR:		ASKEW, OCTAVIAFACILITY TYPE:
735
ADDRESS:4369 PORTOLA DRTELEPHONE:
(424) 789-0439
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 1DATE:
11/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Octavia AskewTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 11/20/2025, Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit to the facility. LPA knocked on the door but there were no clients or staff present. LPA spoke to the Licensee, Octavia Askew at 9:00 am who stated there is one client living at the facility but has been in the hospital since November 14, 2025. LPA met the Licensee at 12:35 pm. LPA stated the purpose of the visit was to complete the annual inspection. The facility is licensed for four ambulatory clients.

Today’s site visit consisted of LPA touring the physical plant inside and outside from 12:35 pm until 1:10 pm. LPA Spaeth observed the following:

Living Room/Dining Room – The living room and dining room are combined. The living room section contained comfortable seating. The dining room area contained a dining room table with dining room chairs.

Kitchen - The facility contained a seven-day supply of non-perishable food and a two-day supply of perishable foods. A fire extinguisher is located in the kitchen. Appliances in the kitchen appeared to be functional. The knives and medications were locked in a kitchen cabinet.

Water Temperature - The water temperature was recorded at 1:40 pm and was 116.0 degrees F.

Continued - 809C

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2025
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: EXCELLENCE COMMUNITY RESIDENTIAL PROPERTIES 2
FACILITY NUMBER: 197610449
VISIT DATE: 11/20/2025
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Backyard - The backyard contained an umbrella for shade and comfortable seating.

Bedrooms - There are three (3) bedrooms which contained bed/beds, a mattress in each bed, linens, night stand, lamp, two chairs, chest of drawers, and a closet.

Bathrooms- There are two bathrooms which contained hand soap, paper towels, and trash can.

Hallway - The hallway cabinet contained clean linens.

Laundry Room – the laundry room contained the washer and dryer.

Garage- LPA observed two locked cabinets which contained storage for the residents’ medications, laundry detergent and cleaning supplies.

Smoke/Carbon monoxide detector – The detectors were tested at 1:00 pm and were operable.

The facility was clean and appears to be in good repair. LPA reviewed the client and staff records from 1:00 pm until 1:50 pm.

There are no deficiencies to report at this time. Exit interview conducted and a copy of the report was given.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC809 (FAS) - (06/04)
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