197610484-4-7-2026-31-AS-ERIS-DSX2HY-20260407172531

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610484
Report Date: 04/07/2026
Date Signed: 04/07/2026 05:32:50 PM

Document Has Been Signed on 04/07/2026 05:32 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:	ALLWALKS THRULIFE RESIDENTIAL, INC		FACILITY NUMBER:	197610484
ADMINISTRATOR/ DIRECTOR:	WALLACE, ANDREA		FACILITY TYPE:	735
ADDRESS:	4138 VAHAN CT		TELEPHONE:	(909) 619-9321
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 4		CENSUS: 5	DATE:	04/07/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Keyondra Cowans - Staff Member		TIME VISIT/ INSPECTION COMPLETED:	05:45 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	Licensing Program Analyst (LPA) Evelin Rios arrived to the facility to conduct an unannounced required annual inspection. LPA met with a staff member who granted access. Staff contacted the administrator, Andrea Wallace by telephone and LPA Rios explained the reason for the visit. This is an Adult Residential Facility (ARF) with an approved fire clearance for 4 ambulatory clients. In the facility LPA observed (1) staff and five (5) clients. Another staff member arrived shortly after. When LPA asked staff member what the census was they responded "five". According to the administrator a client that had already been in the facility would only be in the facility temporarily. According to the administrator and the newest client accepted they had arrived to the facility three months ago. Community Care Licensing Division (CCLD) regional office received a request to increase capacity from four (4) to six (6). On 03/26/2026 CCLD sent the fire department a fire clearance request. CCLD has not received an approved fire clearance to update capacity. According to the administrator the fire inspector was at the facility two days ago. At approximately 9:35 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, and dining area. LPA observed furniture in the common areas in good repair. Dining and living room furniture sits the capacity of the facility. LPA observed one (1) fully charged fire extinguisher, located by the dining area. 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 9:57 AM and 10:02 AM found to be operational. On a table by the living room leading to the backyard LPA observed a live roach. (Continue to LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 14

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)

Page: 2 of 14

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: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
	VISIT DATE: 04/07/2026

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
26
27
28
29
30
31
32

Kitchen: LPA observed a freezer, in the dining area, a refrigerator, stove, microwave and dishwasher. LPA observed a seven day supply of non-perishable food and a two day supply of perishable foods. The facility stores all knives and sharps in a locked kitchen drawer. LPA observed dead roaches in one cabinet were non perishable foods are stored.

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

Bedrooms: There are three (3) bedrooms currently occupied that are being shared. LPA observed bedrooms to be properly furnished with a bed, linens, night stand, chest of drawers, closets, and adequate lighting. A few bedrooms did not have chairs. LPA did not observe any furniture in disrepair.

Bathroom: There is one (1) bathroom for client use on the ground floor. The bathroom is located on the ground floor. Bathroom contained hand soap, paper towels, toilet paper and trash bins. LPA observed dead roaches under the bathroom sink cabinet. Water temperature was taken in bathroom. The temperature located downstairs measured at 120 degrees Fahrenheit. LPA observed night lights leading to the bathroom.

Laundry Room: LPA observed the laundry room on the second floor with the door open accessible to clients. The laundry room contains a washer and dryer.

At approximately 11:20 AM, staff tested the hardwired, interconnected smoke detectors, and LPA observed them to be functioning properly.

Garage: The garage is attached to the facility and is not accessible to clients. The garage is used for storage. LPA observed emergency food and water stored in the garage along with .

Page 2 of 3

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 3 of 14

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: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
	VISIT DATE: 04/07/2026

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
26
27
28
29
30
31
32

Client, Staff and Facility Records: LPA conduct staff file reviews for four staff on schedule. Four (4) staff files were missing Health Screening. Three (3) staff files were missing TB results. LPA also reviewed facility records, such as the Emergency Disaster Plan (LIC610D), Personnel Record (LIC500), and Surety Bond. LPA was not provided copies of fire drills conducted at the facility. According to the administrator emergency drills are conducted and the LIC610 is reviewed with staff annually. LPA reviewed five (5) of (5) client records to ensure compliance with licensing forms. One (1) out of five (5) clients are missing an Admission Agreement. Four (4) out of five (5) clients are missing Needs and Services Plans prior to admission. Four out of five clients do not have a complete medical assessments.

Medications: With the assistance of the staff LPA reviewed centrally stored medication and medication records for proper documentation. Medication records are pre filled by the pharmacy for four (4) out of five (5) clients. One (1) is maintained manually. Facility maintains Medical Administration Records (MAR).

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were deficiencies observed during today's visit. Refer to LIC809D. Appeal Rights provided. An exit Interview was conducted and a copy of the report was provided to staff member Keyondra Cowans.

Page 3 of 3

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 4 of 14

Document Has Been Signed on 04/07/2026 05:32 PM - It Cannot Be Edited

Created By: Evelin Rios On 04/07/2026 at 03:42 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80010(a)

Limitations on Capacity and Ambulatory Status

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interviews and record review, the licensee did not comply with the section cited above in having five clients when their capacity is 4 which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/08/2026
	Plan of Correction
1 2 3 4	The fire inspector has visited the facility and is waiting for the Licensee to install a new fire extinguisher before moving forward with fire clearance request. Licensee will send LPA a statement of understanding regarding the cited regulation on how they will prevent this from happening again. Statement will be sent to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:

	Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 5 of 14

Document Has Been Signed on 04/07/2026 05:32 PM - It Cannot Be Edited

Created By: Evelin Rios On 04/07/2026 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)(1)

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPA observed a live roach and dead roaches in the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/24/2026
	Plan of Correction
1 2 3 4	The licensee will schedule pest control to come out the facility and provide LPA with a copy of the invoice when work is completed by POC due date 04/24/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:

	Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 9 of 14

Document Has Been Signed on 04/07/2026 05:32 PM - It Cannot Be Edited

Created By: Evelin Rios On 04/07/2026 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80066(a)(11)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 4 staff not having TB results documented which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee will have staff provide TB results and a copy of results will be sent to LPA by POC due date 04/17/2026.

Type B

Section Cited

CCR

80068(a)

Admission Agreements

(a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 client not having an admission agreement which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	Licensee will complete admission agreements for client and send copies to LPA by POC due date 04/17/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:

	Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 10 of 14

Document Has Been Signed on 04/07/2026 05:32 PM - It Cannot Be Edited

Created By: Evelin Rios On 04/07/2026 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

85068.2(b)(1)(C)

Needs and Services Plan

(b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (1) The client's desires and background, obtained from the client, the client's family or his/her authorized representative, if any, and licensed professional, where appropriate, regarding the following: (b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (1) The client's desires and background, obtained from the client, the client's family or his/her authorized representative, if any, and licensed professional, where appropriate, regarding the following: (C) The written medical assessment specified in Section 80069. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in four (4) out of (5) clients not having a Needs and Services Plan completed prior to clients' admission which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/24/2026
	Plan of Correction
1 2 3 4	Licensee will complete Appraisals /Needs and Services Plans (LIC625) or Needs and services Plan for each client and provide copy to LPA by POC due date 04/24/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:

	Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 11 of 14

Document Has Been Signed on 04/07/2026 05:32 PM - It Cannot Be Edited

Created By: Evelin Rios On 04/07/2026 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC	FACILITY NUMBER: 197610484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80069(b)

(b) In ARFs, prior to accepting a client into care, the licensee shall obtain and keep on file documentation of the client's medical assessment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in four out of five clients not having a complete medical assessments prior to admission which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/24/2026
	Plan of Correction
1 2 3 4	Licensee will obtain complete medical assessments or Physician's Reports (LIC602) for clients in the facility and provide copies to LPA by POC due date 04/24/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:

	Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026

LIC809 (FAS) - (06/04)

Page: 12 of 14