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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610635
Report Date: 08/22/2025
Date Signed: 08/22/2025 03:35:02 PM

Document Has Been Signed on 08/22/2025 03:35 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:SAND CASTLE RESIDENCES LLCFACILITY NUMBER:
197610635
ADMINISTRATOR/
DIRECTOR:		ALONZO, MARIAFACILITY TYPE:
735
ADDRESS:545 N. AVON STREETTELEPHONE:
(818) 433-7125
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 4CENSUS: 3DATE:
08/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Maria Alonzo - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. Upon arrival, staff on duty was Oscar Perez-House Lead; LPA explained the reason for the visit. At approximately 9:55 am Administrator-Maria "Sandy" Alonzo arrived to the facility. The Adult Residential Facility (ARF) is licensed for 4 ambulatory adults, ages 18 through 59; current census is three (3) ambulatory residents. The program is vendorized through the Frank D. Lanterman Regional Center.

At 10:30 am, LPA toured the facility and observed the following:

Required postings were observed in the kitchen and laundry area. The front entry is the main exit door. There is a second exit door by the breakfast nook and a third sliding door in the dining room; both exits lead to the backyard. The physical plant appeared clean and sanitary, with no visible immediate hazards. There are three fully charged fire extinguishers, in the kitchen, living room and the garage; all fire extinguishers were purchased on 05/09/2025. Facility conducts quarterly safety drills. The last fire and earthquake drill was conducted on 06/29/2025. The smoke and carbon monoxide detectors are hardwired and interconnected. At 11:29 am, the smoke/carbon monoxide detectors were tested and observed to function properly.



Kitchen: The kitchen appliances consisted of a refrigerator, stove, dishwasher, oven and microwave; all the fixtures were observed to be functional. Knives, cutlery and sharp kitchen objects are stored in a locked kitchen cabinet. The cleaning supplies/chemicals were locked in a cabinet underneath the sink. LPA found a sufficient supply of perishable foods (2 days) and non-perishable food (7 days) supplies, with sufficient number of dishes. Kitchen counters, cabinets and appliances were observed to be clean and sanitary.

(Continued on 809C)
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2025
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: SAND CASTLE RESIDENCES LLC
FACILITY NUMBER: 197610635
VISIT DATE: 08/22/2025
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Surrounding grounds: Entry/exits were free of obstruction and hazards. No bodies of water were observed at the facility. There is a shaded area in the backyard, furnished with a table and chairs. There is a locked shed in the side yard, which is currently used as storage. Facility is equipped with non-audio cameras, installed in common areas, front patio and in the yard.

Garage: There is a detached garage with additional storage in the backyard. Laundry machines are located on the side of the garage. The laundry detergents were observed in locked cabinets by the laundry machines. There was also a small refrigerator, with a lock, in the laundry room, used to store medications.

Common Areas: Include a living room by the front door and a breakfast nook by the kitchen. Across from the kitchen there is a dining room with gaming area. In addition there is a family room with a covered, non-functional fireplace. There are ample chairs, sofas, tables and cabinets in each common area rooms.

Bathrooms: There are two (2) full bathrooms for the residents and staff. All toilets and sinks are maintained in sanitary, operating condition. Functional grab bars and non-slip mats were observed in both bathrooms.
Hot water temperature was tested between 112.6 - 115.7 degrees Fahrenheit.

Bedrooms: There are four (4) bedrooms for resident use. Bedroom #1 has a door leading to bathroom #1 but the door is kept locked, since the bathroom is only accessible from the hallway. All of the bedrooms were properly furnished with appropriate chairs, beddings, chest drawers, linens with sufficient lighting. Currently bedroom #2 is vacant.

First-Aid Kit: There are three complete first-aid kits on site with all required supplies and first aid manual.

Staff Files: LPA reviewed records for 4 staff to ensure all required forms are included and trainings are up to date.

Resident Files: LPA conducted a file review of all resident records to ensure compliance of licensing forms. Medications for all three residents were counted and verified for accuracy of administration.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC809 (FAS) - (06/04)
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