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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610820
Report Date: 05/21/2026
Date Signed: 05/21/2026 02:20:24 PM

Document Has Been Signed on 05/21/2026 02:20 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ENCINO SENIOR GARDENSFACILITY NUMBER:
197610820
ADMINISTRATOR/
DIRECTOR:		PANGILINAN, GRANIEFACILITY TYPE:
740
ADDRESS:4930 NOELINE AVE.TELEPHONE:
(909) 782-3853
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: 6CENSUS: 5DATE:
05/21/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Granie Pangilinan, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Tihesha Smith conducted a Component III and Pre-Licensing Inspection for a Change in Ownership with the following representatives: Granie Pangilinan and Pamela Berbardo identity were verified by CA photo ID. The Change in Ownership (CHOW) application to operate the facility received by Community Care Licensing (CCL) on May 09, 2025.

The purpose of today’s visit is to inspect the facility to ensure that the facility is following the rules and regulations of California Code of Regulations, Title 22, Division 6. The facility consists of six (6) bedrooms, four (4) bathrooms for residents, and one (1) bedroom and bathroom for staff. Today's site visit consisted of LPA Smith touring the physical plant inside and outside and the following was observed:

The common areas (kitchen, living room, and dining areas were appropriately furnished, and lighting was adequate. The facility has some perishable and non-perishable food supply with emergency water stored in the kitchen. Appliances in the kitchen appeared to be functional and clean. The living room has a television and comfortable furniture. Games are located on console, and the first aid kit is stored in living room cabinet.

The sharps are stored and locked in kitchen cabinets. The medications are locked in kitchen top cabinet near window and toxins are locked in cabinet near laundry appliances. Laundry area is located at back of kitchen. The laundry appliances are clean and functional.

There are four (4) fire extinguishers: one (1) attached to kitchen wall, one (1) attached to hallway wall, two (2) small ones in living room all were observed to be fully charged. Additional new fire extinguisher in container.

Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at time of visit. LPA observed the required facility postings.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Tihesha Smith
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2026
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ENCINO SENIOR GARDENS
FACILITY NUMBER: 197610820
VISIT DATE: 05/21/2026
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(cont from 809)
All residents’ bedrooms contained required furniture: nightstand, lamp, dresser, and chair. Bathrooms have trash cans, nonslip mats and grab bars. Bathroom water temperature at: 118 degrees Fahrenheit. Extra linens are stored in hall closet.

Staff and residents’ files stored in cabinet in dining room.

Backyard has sufficient seating and observed to be functional. Retractable awning available for shade.

No garage

The facility has an attic. The entrance to the attic is located in the hallway between resident rooms 5 and 6, and the door was locked at the time of observation. LPA Smith observed the upper level from outside the facility and noted that the attic has one window at the front of the house and another on the side, both equipped with blinds or shades.

Component III presentation conducted at 10:20 a.m. and upon completion the administrators acknowledged understanding.

The following items require correction/inspection:

Replace missing smoke detector in hallway

Licensee will email LPA Smith when locked attic area is ready to be inspected

Copy of this report will be forwarded to the CAB specialist.

Exit interview was conducted and a copy of report was issued.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Tihesha Smith
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC809 (FAS) - (06/04)
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