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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005941
Report Date: 03/30/2026
Date Signed: 03/30/2026 01:42:11 PM

Document Has Been Signed on 03/30/2026 01:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HORWITZ FAMILY HOUSEFACILITY NUMBER:
306005941
ADMINISTRATOR/
DIRECTOR:		MCDONALD, LISAFACILITY TYPE:
735
ADDRESS:1621 PORTOLA AVENUETELEPHONE:
(818) 782-2211
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 3DATE:
03/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Program Director Nolette UntalanTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On March 30, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Program Director (PD) Nolette Untalan was notified via telephone and later arrived to assist with the inspection. LPA observed that Nolette Untalan has a valid Administrator certificate which expires on June 20, 2027.

The facility is an Adult Residential Facility (ARF) licensed for six ambulatory clients. The facility is a two story home with six private client bedrooms, three shared client bathrooms, a living room, a family room, a bonus room, a kitchen, and an attached two car garage. LPA, accompanied by a staff, conducted a tour of the interior portions of the facility. LPA inspected the six private client bedrooms and they were observed to be free of hazards. LPA observed client bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed client beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the three client bathrooms and observed them to be clean. Faucets and toilets were operational. Hot water temperature measured between 125.6 and 125.9 degrees Fahrenheit.

LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed fire extinguishers to be mounted on the wall in the kitchen and on the second story of the home. LPA observed fire extinguishers to be charged and serviced as of January 20, 2026. LPA observed the facility conducted their last emergency disaster drill on March 20, 2026. CONTINUED ON 809-C
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2026
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HORWITZ FAMILY HOUSE
FACILITY NUMBER: 306005941
VISIT DATE: 03/30/2026
NARRATIVE
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LPA observed the centrally stored medication to be kept in a locked closet by the kitchen. LPA observed a first aid kit to be stored in a closet by the kitchen and it had all the required components. LPA observed a fire place in the living room and it was adequately fenced and not in operation at time of visit. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to clients in care. LPA observed the garage to be used for storage. LPA observed chemicals and toxins to be stored in the locked cabinet in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage.
LPA, accompanied by a staff, conducted a tour of the exterior portion of the facility and observed it to be free of hazards. LPA observed a shaded outdoor area with furniture for client use. LPA observed the perimeter gates of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises.

LPA reviewed all three client files. LPA observed that the Individual Program Plan (IPP), for all three clients were outdated and were more than one year old. LPA reviewed clients' medication and medication administration records. The facility handles Personal and Incidental expense monies (P&I) for one client. LPA reviewed the P&I for the one client. LPA reviewed six staff files. LPA also observed that Staff #3 (S3) started their employment with the facility on February 12, 2026, however, S3 does not have a criminal record clearance and is not associated to the facility.

Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. A civil penalty is also be assessed in the amount of $500.00 for a criminal record clearance violation. An exit interview was conducted with Program Director Nolette Untalan. A copy of the report and Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/30/2026 01:42 PM - It Cannot Be Edited


Created By: Brandon Lopez On 03/30/2026 at 01:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HORWITZ FAMILY HOUSE
FACILITY NUMBER: 306005941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80019(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA also observed that Staff #3 (S3) started their employment with the facility on February 12, 2026, however, S3 does not have a criminal record clearance and is not associated to the facility.
POC Due Date: 03/31/2026
Plan of Correction
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The Program Director stated that they will not allow S3 to work at the facility until S3 obtains a criminal record clearance. The Program Director agreed to provide LPA a plan on when they have S3 complete a livescan. The Program Director agreed to provide LPA the plan via email or fax by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/30/2026 01:42 PM - It Cannot Be Edited


Created By: Brandon Lopez On 03/30/2026 at 01:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HORWITZ FAMILY HOUSE
FACILITY NUMBER: 306005941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80068.2(b)(1)
(b) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the Individual Program Plan (IPP), for all three clients were outdated and were more than one year old.
POC Due Date: 04/10/2026
Plan of Correction
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The Program Director stated that they will either obtain an updated Individual Program Plan for all three clients, or will create their own. The Program Director agreed to provide LPA the updated Individual Program Plan for all three clients via email or fax by POC date.
Type B
Section Cited
CCR
80088(e)(1)
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing
fixtures used by clietns to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA tested the hot water temperature in the client bathrooms which measured between 125.6 and 125.9 degrees Fahrenheit.
POC Due Date: 04/10/2026
Plan of Correction
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The Program Director stated that they will adjust the hot water temperature to be within regulatory requirements and will document the changes on a water temperature log. The Program Director agreed to provide LPA a copy of the adjusted hot water temperature log via email or fax by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2026


LIC809 (FAS) - (06/04)
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