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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800005
Report Date: 05/06/2026
Date Signed: 05/06/2026 05:25:06 PM

Document Has Been Signed on 05/06/2026 05:25 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GEMILAN HOME CARE CENTERFACILITY NUMBER:
565800005
ADMINISTRATOR/
DIRECTOR:		MELANIE MARINFACILITY TYPE:
735
ADDRESS:4310 CASPER COURTTELEPHONE:
(805) 488-9424
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 4DATE:
05/06/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:47 PM
MET WITH:Delia Cafuir, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. At 10:30 a.m., the LPA arrived at the facility, however no one answered the door nor the telephone. LPA returned to the facility at 02:47 p.m. and was greeted by staff. Licensee arrived at 03:30 p.m. Entrance interview conducted.

RECORD REVIEW: Beginning at 03:03 p.m. (client files) and 03:56 p.m. (staff files), LPA conducted a file review for all four (4) clients and for five (5) staff and observed the following: Staff have current first aid and training completed. Client records were reviewed for, but not limited to current Individual Programming Plan (IPP), medical records, P & I funds, admissions agreement, and consent forms. All records were in order. The last earthquake drill took place on 04/28/2026 and fire drill on 03/27/2026. Administrator’s Certificate is valid until 07/24/2027. The LPA observed documentation of the Infection Control Plan and obtained a copy of the Emergency and Disaster Plan.

The facility is vendored by Tri-Counties Regional Center. Beginning at 03:43 p.m., the LPA, along with Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 regulation. The following was observed:

Facility is a single-story residence that consists of four (4) bedrooms, three (3) for client use and one (1) for staff use and two (2) bathrooms.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2026
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: GEMILAN HOME CARE CENTER
FACILITY NUMBER: 565800005
VISIT DATE: 05/06/2026
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OUTDOOR SPACE: The LPA observed the back patio which has a covered area equipped with furniture for client use. There are no bodies of water on the premises. There is a side gate for emergencies and is single-latched.

GARAGE: The garage is attached to the house. Washer and dryer units are located inside the garage. Emergency water and additional food is located inside the garage. Additional cleaning supplies and disinfectants are kept in locked cabinets in the garage.

COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 04/09/2026. At 04:53 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Facility telephone was observed during the time of the visit. Medications and first aid are located inside a locked cabinets near the kitchen area.

KITCHEN: The LPA observed the kitchen and dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives are stored in a locked kitchen cabinet. Cleaning solutions, and chemicals are inaccessible to clients in care.

BEDROOMS: The LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. The LPA observed a linen closet in the hallway with extra towels and blankets.

RESTROOMS: Client restroom is relatively clean and sanitary and in operating condition. Hot water temperature measured within the required range. The sink had sufficient liquid soap, and paper towels.

MEDICATION REVIEW: Beginning at 04:38 p.m., the LPA conducted a review of medication and medication documentation with the Licensee for two (2) clients and observed that medications were properly documented and appear to be self administered as prescribed.

INTERVIEWS: Throughout the visit, LPA conducted interviews with one (1) staff and interviewed one (1) client. No concerns were noted.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC809 (FAS) - (06/04)
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