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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703776
Report Date: 08/26/2025
Date Signed: 08/26/2025 09:44:48 PM

Document Has Been Signed on 08/26/2025 09:44 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:BARNARD FAMILY HOMEFACILITY NUMBER:
561703776
ADMINISTRATOR/
DIRECTOR:		KARLA IBARRAFACILITY TYPE:
735
ADDRESS:4780 BARNARD STREETTELEPHONE:
(805) 526-0043
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 6CENSUS: 4DATE:
08/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Karla ValdezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 1:17 P.M. Upon arrival, there were two (2) staff and three (3) clients. One (1) client was at day program at the time of the visit. LPA was greeted by facility staff who contacted the facility administrator via telephone. Administrator and Licensee, Karla Valdez and Juan Valdez arrived at the facility at approximately 1:25 P.M. The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 2-i home. Surety Bond is current. Entrance interview conducted.

Beginning at 1:30 P.M., the LPA along with the Administrator and the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Refrigerator and dry food pantry were checked for proper labels and expiration dates and food labels had expiration dates clearly marked. Knives and sharps were observed in a locked drawer by the gas range. The kitchen faucet was measured for water temperature, and it measured 114.2 degrees Fahrenheit at 1:50 P.M.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2025
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 4
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: BARNARD FAMILY HOME
FACILITY NUMBER: 561703776
VISIT DATE: 08/26/2025
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Continued from LIC 809-C

BEDROOMS: There are three (3) total bedrooms in the facility for clients, at the time of the visit LPA observed one (1) shared room and two (2) rooms were for single occupancy. All client rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Facility has two (2) staff rooms.

BATHROOMS: There are two (2) bathrooms for client use. Bathrooms were observed to be equipped with slip-resistant surfaces. Starting at 1:45 P.M., the water temperature was measured in both bathrooms, and they measured between 106 and 112 degrees Fahrenheit. There is a bathroom adjacent to the kitchen leading to the “staff quarter”. Per licensee, room was used as a staff room. At the time of the visit room was vacant.

COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished at the time of the visit. Fire extinguisher was observed to be fully charged on 07/10/2025. Between 1:35 P.M. and 1:55 P.M. combination smoke and carbon monoxide detectors were tested, and all were functional at the time of the visit.

OUTDOOR (BACKYARD/FRONT YARD): The washer and dryer are in the back yard. Residents are responsible for their own laundry needs; however, staff will assist if needed. Detergents and cleaning solutions were observed in a locked and inaccessible shed. All passageways were observed to be clear of any obstructions. There were no bodies of water noted at the time of the visit. LPA observed one (1) self-latching gate for emergency use. The front yard is equipped with furniture for client use.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
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: BARNARD FAMILY HOME
FACILITY NUMBER: 561703776
VISIT DATE: 08/26/2025
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Continued from LIC 809-C

RECORD REVIEW: At 2:45 P.M. LPA reviewed four (4) client records and four (4) personnel records including the current Administrator’s file starting at 2:15 P.M. Client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan/IPP. All files were complete. The Facility does handle cash resources for all clients. Ledgers were accurate. Personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR/CPI training, and the appropriate yearly training. All records were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last one being a earthquake drill and conducted on 05/15/2025.

MEDICATION REVIEW: At 2:45 P.M. LPA conducted a medication review for three (3) clients. Medications are locked in a filing cabinet in the dining room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given as prescribed at the time of the visit.

During today’s visit, LPA conducted an interview with one (1) client.

No citations issued at this time. Exit interview conducted. The report was reviewed, and a copy was provided.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4