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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802255
Report Date: 07/29/2026
Date Signed: 07/29/2026 12:42:12 PM

Document Has Been Signed on 07/29/2026 12:42 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GALLAGHER ADULT FAMILY HOMEFACILITY NUMBER:
405802255
ADMINISTRATOR/
DIRECTOR:		HICKS, AMYFACILITY TYPE:
735
ADDRESS:809 VISTA CERRO DRIVETELEPHONE:
(805) 238-4668
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 4CENSUS: 4DATE:
07/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Licensee - Jennifer GallagherTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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At 8:00am, on 07/29/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee Jennifer Gallagher, announced who he was and the reason for the visit.

Licensee and LPA conducted a full tour of the facility. This facility is a two-story residential home that has six bedrooms and four and a half bathrooms. On the first floor there is a family room with office space, shared half bathroom, a living room with a couch and dining space, a kitchen with bar seating, there are three client bedrooms (one has an en-suite full bathroom), a full shared bathroom, and the primary bedroom is for live-in staff with en-suite bathroom. The first floor also has access to the garage and a laundry room with chemicals stored in locked cabinets for client safety. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely. In the family room LPA noted a self contained fireplace for client safety. At 8:38am while touring the garage LPA observed a wooden piece of furniture between the garage doors, the furniture has two drawers and in the top drawer was a metal manual key lock box with the key in the drawer right next to the box. Staff #1 (S1) opened the box for the LPA, inside was a grey pouch containing a small revolver firearm. S1 stated the firearm is nonfunctional, there is no ammunition at the facility, and there are no other guns at the facility. The box containing this firearm does not meet the regulatory standards established by the Department of Justice in Section 4100 of Title 11 of the California Code of Regulations. LPA did not observe ammunition or additional firearms during tour.

On the second floor is a common area with a couch, a full kitchen, outdoor patio space for common use, a full bathroom for client use, and one client bedroom.LPA noted that the backyard, side yard and the front yard have seating and shade for clients and staff.


(Continued on LIC809-C)
Kelly Burley
Garrett Haner-Tomasko
DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2026
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 4
Document Has Been Signed on 07/29/2026 12:42 PM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 07/29/2026 at 11:07 AM
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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GALLAGHER ADULT FAMILY HOME
FACILITY NUMBER: 405802255

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1567.92(c)(1)
1567.92 Firearms on Facility Premises
A licensee that permits clients to possess firearms on the facility premises shall do all of the following:
(c) Clients’ and licensees’ firearms, ammunition, or both shall be centrally stored in the facility and in the following manner:
(1) Firearms shall be centrally stored unloaded, in a locked gun safe, that meets the regulatory standards established by the Department of Justice in Section 4100 of Title 11 of the California Code of Regulations.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above when a small revolver firearm was not stored according to regulatory standards established by the Department of Justice which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2026
Plan of Correction
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S1 placed the firearm back into the metal lock box, locked it up and removed the key. When S1 returns to the facility today they will ensure the firearm is removed from the premises or placed in approved storage. Licensee states they will create a letter of understanding of this regulation and email it to the LPA on or before 8/2/2026.
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.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Garrett Haner-Tomasko
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2026


LIC809 (FAS) - (06/04)
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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: GALLAGHER ADULT FAMILY HOME
FACILITY NUMBER: 405802255
VISIT DATE: 07/29/2026
NARRATIVE
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The facility has battery operated smoke detectors in each bedroom that are all working, the carbon monoxide detector is in the hallway on the first floor and near the kitchen on the second floor both functioning normally. LPA observed a fire extinguisher near the laundry room that was tagged current and in the green compression range, serviced on 4/20/2026. LPA tested facility hot water at 115.0°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Medications are locked in the kitchen area. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. Staff and client files are locked in the family room. LPA conducted a staff and resident file review.

LPA and Licensee conducted a review of the annual care tool modules.

Exit interview conducted, deficiency cited on LIC809-D page, a civil penalty in the amount of $500 for firearm violation is being assessed on the attached LIC421IM, appeal rights and report provided to the Licensee.
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
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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