198600915-9-20-2025-31-AS-MCAA-DLPTQJ-20250920145602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600915
Report Date: 09/20/2025
Date Signed: 09/20/2025 02:56:08 PM

Document Has Been Signed on 09/20/2025 02:56 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:	D4, INC.		FACILITY NUMBER:	198600915
ADMINISTRATOR/ DIRECTOR:	FRANCISCO ESPINOZA		FACILITY TYPE:	735
ADDRESS:	4541 N FIGUEROA ST		TELEPHONE:	(323) 223-1221
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90065
CAPACITY: 100		CENSUS: 79	DATE:	09/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:39 AM
MET WITH:	Francisco Espinoza		TIME VISIT/ INSPECTION COMPLETED:	03:00 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 Analysts (LPAs) Jose Gary Tan and Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Francisco Espinoza , and explained the reason for the visit. With the assistance of the administrator, a tour of the physical plant was made. The facility is licensed for 100 clients ages 18 - 59, Ambulatory only. The facility consists of three (3) buildings housing women and men clients. All three buildings have two floors. During this visit LPAs observed the following: Main Building, consist of fifteen(15) client rooms and twenty (20) bathrooms, kitchen and dining area. The second building-Casa Bonita, consist of five (5) clients rooms three (3) bathrooms, common area/TV room. The third building, Casa Chequita, which consist of five (5) clients rooms three (3) bathrooms, TV room/common area, front patio and back patios. There is a fish pond near the front patio that is gated. LPA inspected randomly selected rooms in all three buildings. The last emergency drill was conducted July 10, 2025. Fire Protection by the Fire Department last made March 31, 2025. Kitchen: The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperatures. There was a sufficient amount of perishable and non-perishable food at the facility and properly stored. Residents do not have access to the kitchen. The food stored in the refrigerator was covered appropriately. Bedrooms: All three building were inspected in random bases. Bedrooms inspected appeared to be clean and comfortable. Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Resident rooms were inspected and observed with all required furnishings, sufficient lighting and closet space. The facility carries a sufficient supply of extra linen and towels for the client needs. Floors were observed mop and clean. Exits from resident rooms were clear of obstruction.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

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 3

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 3

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: D4, INC.	FACILITY NUMBER: 198600915
	VISIT DATE: 09/20/2025

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

Bathrooms: Resident bathrooms in all three buildings were properly supplied and had functional fixtures. Hot water temperature in random resident bathrooms on all three buildings were checked and measured at a range of 107°F to 112°F.

Common Areas: Each building has a TV room and activity area. The Smoke detectors are hardwired throughout all buildings. There are intercoms in all rooms and bathrooms that are connected to the office. The intercom system was checked from randomly selected rooms and appeared to be functional. There are fire extinguishers stationed throughout all three buildings. The charge date for the fire extinguishers is March 19, 2025.

Surrounding Grounds: There are security cameras and fencing in place. There were no visible hazards. There was furniture appropriate for outdoor use.

Laundry: There are two laundry areas located at building #2 and #3. Laundry areas were checked and was locked during the day of the visit.

Staff Office/Work Station: Administrator's office is located on the first floor, in building #1.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Centralized medication is located in building #1. Medication room is locked at all times. Medications were checked for proper storage and documentation. Medication documentation and implementation appeared to be complete. First aid kit and manual is maintained in the medication room.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3