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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421703549
Report Date: 07/21/2026
Date Signed: 07/30/2026 08:42:22 AM

Document Has Been Signed on 07/30/2026 08:42 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)FACILITY NUMBER:
421703549
ADMINISTRATOR/
DIRECTOR:		ENEDILIA AVILAFACILITY TYPE:
740
ADDRESS:6960 DEVEREUX WAYTELEPHONE:
(805) 845-7717
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 15CENSUS: 13DATE:
07/21/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Sydney Steiner, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual required inspection at the above-named facility. Upon arrival, LPA was greeted by Monica Gomez, Clinical Case Manager and explained the purpose of the visit. Sydney Steiner, Program Manager accompanied LPA during the visit. Jennifer Farley, Program Director was unavailable at the time of the visit. LPA explained the purpose of the visit. There are currently fifteen (15) clients residing in the facility. At the time of arrival, there were eight (8) clients present with five (5) staff on duty. Clients not present were attending day programs and/or appointments away from the facility.

Entrance interview conducted.
The facility is a one-story home to Clients with intellectual/developmental disabilities, has a fire clearance for 15 non-ambulatory clients and a hospice waiver for 2 clients. There is one resident currently on hospice. The facility contracts with Tri-Counties Regional Center.
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service.
The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. At approximately 2:25 pm, LPA observed approximately 22 areas throughout the facility in need of patching and painting. Said areas included hallways, door jams, and other areas.
LPA observed four (4) fire extinguishers serviced on 3/14/2026 and 4/27/2026, two (2) carbon monoxide detectors in good working order, 27 smoke alarms, and an automatic sprinkler system throughout the building.

Please continue to 809-C, Pg 2.

Kelly Burley
Kristin Kontilis
DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2026
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)
FACILITY NUMBER: 421703549
VISIT DATE: 07/21/2026
NARRATIVE
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 The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerators, stove, and counters are clean.
A weekly house meeting is conducted with Staff in Charge (SIC) to discuss clients’ activities and planning for the activities for the upcoming week. Clients participate at will in activities with music appreciation, virtual reality tours, holiday celebrations, birthdays, self-accomplishment celebrations, weekly acknowledgements, painting projects, Bingo, and greenhouse planting. Local excursions include going to movie theaters, lunch outings, breakfast outings, museums, shopping, concerts in the park, and beach outings.
Medications and First Aid kits are kept in the locked staff office in a locked medication cart.
Meals are prepared by the staff and staff assist with meal distribution and assisting clients with safety precautions and special diet accommodations. Snacks are available throughout the day. Clients may volunteer to complete chores throughout the facility if desired.
The front entrance consists of an open porch with a bench located near the front door. The facility maintains a comfortable temperature and there are no bodies of water.
The facility has twelve (12) bedrooms. Bedrooms #1, 5, and 9 are shared bedrooms. Bedroom #9 has a private bathroom for the two occupants. Bedrooms #11 and 12 are single rooms with a shared bathroom between the two rooms. Bedrooms #2, 3, 4, 6, 7, 8 and 10 are private bedrooms. There are 5 bathrooms with access from the hallway available to all clients and staff. The bathrooms have secure grab bars.
Personnel documents reviewed revealed an adequate number of training hours has been completed; health screenings were complete, and all staff have been properly associated to the facility.
Clients records reviewed revealed admission agreements, appraisals, needs and services plans, and health screenings were complete.
On 3/26/2026, the facility self-reported an incident stating on 3/23/2026 Client 1 (C1) was administered 1 tablet of Lorazepam 2mg as a PRN. Dr.’s order states ‘administer 1 tablet of Lorazepam 1 mg and wait one hour before administering Lorazepam 2mg'. Staff 1 (S1) did not follow Client’s PRN order per Doctor's prescription and protocol.
On 1/22/2026, the facility self-reported an incident wherein on 1/16/2026 Client 2 (C2) was administered PRN Lorazepam 1 mg tablet from another client’s medication supply.
Program Manager stated S1 and S1 were counseled on the errors, conducted re-training, and are no longer employed by the Licensee.
Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D):
Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit.
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2026 08:42 AM - It Cannot Be Edited


Created By: Kristin Kontilis On 07/21/2026 at 04:38 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: DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)
FACILITY NUMBER: 421703549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(2)
87465(c)(2) Incidental and Medical Care: ....Once ordered by the physician the medication is given according to the physician's directions.
This requirement has not been 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 when the facility self-reported two medication errors which occurred on 1/16/2026 and 3/26/2026 which poses a potential health and safety risk to residents in care.
POC Due Date: 07/21/2026
Plan of Correction
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Program Manager stated S1 & S2 were counseled and conducted re-training; S1 & S2 are no longer employed by the facility. POC cleared at the time of the inspection.
Type B
Section Cited
CCR
87303(a)
87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed hallways and door jams throughout the facility in need of patching and painting which poses a potential safety and well-being of clients in care.
POC Due Date: 07/31/2026
Plan of Correction
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Licensee agrees to conduct thorough patching and painting as needed throughout the facility including but not limited to hallways, doorways, and other maintenance no later than due date. Licensee agrees to send photos directly to LPA of the finished work no later than POC due 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.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Kristin Kontilis
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2026


LIC809 (FAS) - (06/04)
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