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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600051
Report Date: 05/12/2025
Date Signed: 05/12/2025 07:28:13 PM

Document Has Been Signed on 05/12/2025 07:28 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ETTA ISRAEL CENTER ADULT RESIDENTIAL #2FACILITY NUMBER:
198600051
ADMINISTRATOR/
DIRECTOR:		HEIDI SCHOFIELDFACILITY TYPE:
735
ADDRESS:6053 ALCOVETELEPHONE:
(818) 358-3290
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 6DATE:
05/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Heidi Schofield, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:35 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection visit using the complete CARE Inspection Tool and met with Heidi Schofield, Administrator. Also participating in today's visit was Xiomara Cruz, House Manager. The reason for today's visit was provided.

The home is a two storey family home consisting of a living room, dining room, a kitchen, 6 client bedrooms, 4-1/2 bathrooms and a attached garage. The facility is fire cleared for 6 AMBULATORY clients. The facility is vendorized by North Los Angeles County Regional Center as a 4G(level 5) home.

On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. Also reviewed on today's visit were 6 staff files, 2 client files, Emergency Disaster Preparedness Plan and Infection Control Plan. A tour of the physical plant was also conducted.

The following were observed:
  • the living room and dining room was furnished with sufficient seating for 6 residents.
  • the kitchen is equipped with a stove, ovens, microwave and a dishwasher. Medications and sharp knives are stored in locked kitchen cabinets and cleaning solutions are stored in a locked cabinet under the sink. The only 2 fire extinguishers, tested on 10/2/24 were located in the kitchen and the laundry room.
  • Located by the kitchen is the laundry room equipped with a washer and dryer. Also located in the laundry room is the food pantry with part of the facility's non-perishable foods. The remaining non-perishable foods were observed stored in the locked garage and was sufficient for a minimum of 7 days. Sufficient perishable foods for a minimum of 2 days were observed in the refrigerator.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ETTA ISRAEL CENTER ADULT RESIDENTIAL #2
FACILITY NUMBER: 198600051
VISIT DATE: 05/12/2025
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  • all 6 client bedrooms were observed with the required bed, chair, dresser, lamp and closet(s).
  • all the clients beds were observed with the required linens on the beds or in their closets if the clients refused certain linens.
  • extra linens and towels were observed in the linen closets located in front of bedroom #2 and bedroom #4.
  • fully equipped Jack and Jill bathrooms are located between bedroom #1 and #3 and bedroom #2 and #4. Bedroom #5 and bedroom #6 have private bathrooms. Water temperature tested in bedroom #1 and #3 read 114.5, bedroom # 2 and #4 read 111, bedroom #5 read 115.3, bedroom #6 read 115.3 and the common bathroom located downstairs read 106.7 degrees Fahrenheit.
  • Grab bars and slip resistant mats were observed in the bathrooms.
  • Carbon monoxide detectors were observed at the top and bottom of the stairs. Both were tested and were operational
  • The hardwired smoke detectors located in all the resident bedrooms and one in the hallway were tested and were operational. The facility also has a pull alarm system.
  • Per tour of the backyard, a covered patio equipped with a table and plenty of chairs for activities were observed. Trash cans were on the street waiting for trash pick up. The backyard is enclosed with a fence and side gates for exit.
  • The inside and outside areas were observed to be clean and well maintained.
  • Per review of 6 staff files, staff have current first aid training and the required documents.
  • Per review of 2 client files, clients all have the required documents.
  • Administrator certificate is current
  • The last fire ill was conducted on 4/28/25.

No deficiencies were cited on today's visit.
Exit interview was conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC809 (FAS) - (06/04)
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