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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610767
Report Date: 04/17/2025
Date Signed: 04/17/2025 11:37:03 AM

Document Has Been Signed on 04/17/2025 11:37 AM - 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:OASIS BEHAVIORAL HEALTHFACILITY NUMBER:
197610767
ADMINISTRATOR/
DIRECTOR:		GUERRERO, ADAMFACILITY TYPE:
772
ADDRESS:4755 AMIGO BLVDTELEPHONE:
(917) 374-4215
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY: 6CENSUS: 0DATE:
04/17/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Katarina BoshoffTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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At 9:30 a.m. on 04/17/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing visit. LPA met with the Director and disclosed the reason for the visit.

Today’s prelicensing inspection is for a Change of Location with no clients in care. The facility had no clients in care and no other staff on site. It is a two-story building with four (04) bedrooms, five (05) bathrooms, kitchen, laundry area, common areas, and outdoor areas. It has an approved fire clearance for six (06) ambulatory clients.

The main entrance is gated with a pin pad for entry. The gate was unlocked and open. The front yard contained a drive way and steps with slip-resistant strips leading to the main entrance. Postings near the main entrance included COVID precautions, confidential complaints contacts, emergency disaster plan, personal rights, visitation policy, grievance procedure, house rules, emergency contacts, activity calendar, and the facility sketch with exits labelled. A screening station at the front contained sanitizer, a digital thermometer, and a visitor log.

Walls, floors, windows, screens, baseboards, curtains, and blinds were clean and in good repair. At 9:40 a.m. LPA measured the room temperature to be 72 degrees Fahrenheit. An activity area contained furniture in good repair. The front living room contained a television, a grated fireplace, and furniture in good repair. The rear living room contained a television, reading materials, art supplies, a billiards table, and furniture in good repair. The Director noted that walls were freshly painted and baseboards were new. Stairs leading to the second floor also had slip-resistant strips. Staff rooms on the first and second floors were free of hazards.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2025
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: OASIS BEHAVIORAL HEALTH
FACILITY NUMBER: 197610767
VISIT DATE: 04/17/2025
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LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Emergency food, water, and backpacks were also located near the kitchen. Appliances were in good condition. The stove surface and hood were clean. Sharps and cleaning solutions were locked under counter tops. Secondary lock boxes were available for sharps as well. At 9:50 a.m., LPA measured the refrigerator temperature to be 38 degrees Fahrenheit. Two complete first aid kits were present in the kitchen, too. At approximately 10:00 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last tested on 11/24/24 with a tag attached. The rear of the facility contained outdoor spaces, a basketball court, a golf area, a fire pit, shaded patio furniture, and a fenced and locked swimming pool. An additional staff office was separate from the main facility.

The facility had four (04) bedrooms. Two (02) bedrooms were private, and two (02) bedrooms were shared. All bedrooms contained a chair, lamp, nightstand, storage, evacuation ladders, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #1 had a balcony. Bedroom #4 had a private bathroom. Hallway closets had adequate supplies of fresh linens and towels along with art supplies and board games.The facility had five (05) bathrooms. Bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, a non-skid mat in the shower. At approximately 10:45 a.m. LPA measured the water temperature to be 114.1 degrees Fahrenheit.

A washing machine and dryer were located in the laundry area. Both were in working order. Detergents and cleaning supplies were locked in a closet next to the appliances. The medication room was locked and contained a locked medication cart, PPE, two refrigerators for medications and specimen analysis, an extra first aid kit, an Automated External Defibrillator (AED), and confidential files.

All emergency exit paths were free from obstructions. Exit signs were illuminated. Three (03) out of three (03) exit doors were unlocked. At approximately 11:00 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and functioned simultaneously. LPA called out from the house telephone at 11:10 a.m. The phone was deemed operational. Cameras were used in common areas.

At 11:20 a.m. LPA and the Director reviewed the Compliance and Regulatory Enforcement (CARE) Tools.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health or safety hazards were observed.

Pre-Licensing is complete. This facility has no deficiencies. Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC809 (FAS) - (06/04)
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