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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850413
Report Date: 04/16/2026
Date Signed: 04/17/2026 08:27:21 AM

Document Has Been Signed on 04/17/2026 08:27 AM - 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:GINA SCHWICHTENBERG ARF IIIFACILITY NUMBER:
405850413
ADMINISTRATOR/
DIRECTOR:		SCHWICHTENBERG, GINAFACILITY TYPE:
735
ADDRESS:241 CHEYENNE DRTELEPHONE:
(805) 221-5103
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 4CENSUS: 4DATE:
04/16/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:50 AM
MET WITH:Backup Administrator - Jacob RiceTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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 At 07:50am, on 04/16/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator Jacob Rice, announced who he was and the reason for the visit.

At 8:00am Backup administrator and LPA conducted a full tour of the facility. This facility is a single-story residential home with two dual occupancy client bedrooms, a live-in staff bedroom, and two full bathrooms (one en-suite to the staff bedroom and the other for client/shared use). There is a living room with an office space, a dining room and kitchen. Access to the laundry area and garage is through a locked door. At 8:09am LPA noted a room located in the garage not included in the facility sketch and fire clearance, inside the room is a bed with all linens, personal belongings of Client #1 (C1), LPA noted the room has no smoke detector and the light switch has no faceplate leaving electrical wires accessible. The room in the garage is only accessible through the garage, during today's visit LPA and Backup Administrator noted in the garage multiple containers with various amounts of motor oil in them and two electrical outlets with no faceplate leaving electrical wires and chemicals accessible to C1. Licensee stated that C1 has occupied the room in the garage on and off for approximately nine (9) months, prior it was used as an office for the Licensee. Interviews revealed C1 slept in the room in the garage as recent as last night when the motor oil was in the garage and that C1 prefers to sleep in this room. C1 also has all required furnishings in a shared bedroom inside the facility and as of today's visit the Licensee states C1 will only reside in a cleared bedroom until the room in the garage is cleared by fire. LPA noted that the backyard has seating and shade for clients to enjoy. LPA noted an underground jacuzzi in the backyard that is not used with a cover that can support the weight of an adult. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely.

(Continued on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2026
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 8
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: GINA SCHWICHTENBERG ARF III
FACILITY NUMBER: 405850413
VISIT DATE: 04/16/2026
NARRATIVE
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The facility has wired smoke detectors in each cleared bedroom that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher in a non-lockable closet in the hallway that was tagged current and in the green compression range, serviced on 05/22/2025. LPA tested facility hot water at 135.0°F, not 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 and staff and client files are locked in a cabinet. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review.

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

Exit interview conduct, deficiencies cited on LIC809-D pages, a civil penalty in the amount of $500 for a fire clearance violation is being assessed on the attached LIC 421IM, report signed, report and appeal rights provided to Backup Administrator.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 04/17/2026 08:27 AM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 04/16/2026 at 04:50 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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GINA SCHWICHTENBERG ARF III
FACILITY NUMBER: 405850413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients 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 when the hot water in the shared client bathroom was tested at 135.0*F which poses an immediate health and safety risk to persons in care.
POC Due Date: 04/17/2026
Plan of Correction
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Backup Administrator adjust the tanked water heater temperture during the visit. Backup Administrator will create a hot water temperture check log and frequency of checks policy and submit this to the LPA on or before 4/23/2026.
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above when the licensee allowed C1 to reside and sleep in an uncleared room in the garage which poses an immediate health and safety risk to persons in care.
POC Due Date: 04/17/2026
Plan of Correction
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Licensee stated they will ensue that C1 does not reside or use the room in the garage to sleep in starting today. Backup Administrtor will ensure the garage door is locked when not attended. Backup Administrator will conduct staff training on this regulation and the safety violation. They will submit staff training and signed roster to LPA on or before 4/23/2026.
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: 04/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2026


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 04/17/2026 08:27 AM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 04/16/2026 at 04:50 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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GINA SCHWICHTENBERG ARF III
FACILITY NUMBER: 405850413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above when electrical wires and motor oil were accessible to clients in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/20/2026
Plan of Correction
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Backup Administrator removed the containers of oil during the visit and will cover the outlets and lightswitch on or before 4/20/2026 and submit photos to LPA.
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: 04/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2026


LIC809 (FAS) - (06/04)
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