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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801215
Report Date: 08/25/2026
Date Signed: 08/25/2026 02:42:14 PM

Document Has Been Signed on 08/25/2026 02:42 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ANGELS IIFACILITY NUMBER:
565801215
ADMINISTRATOR/
DIRECTOR:		JOANN TRUPIANOFACILITY TYPE:
740
ADDRESS:2375 MCDONALD COURTTELEPHONE:
(805) 404-5201
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 6CENSUS: 4DATE:
08/25/2026
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Joann TrupianoTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced cased management – legal/non-compliance visit.  LPA met with staff and explained the reason for the visit. Licensee Joann Trupiano arrived shortly after. The LPA focused today’s visit on ensuring there are no health and safety hazards and to ensure the facility is maintaining substantial compliance per Stipulation CDSS No. 6124211301-C , Subject ID No. 7501152976 ordered on 05/29/2026.
 
At approx 10:30 a.m. conducted a walk through of the facility. Resident rooms were observed to be furnished appropriately with sufficient lighting. One (1) resident was eating watermelon at the dining table and another resident was in the living room with a family member. Resident bathrooms were sufficiently stocked with supplies and paper towels. Hot water temperature  measured within 105- and 120-degrees Fahrenheit. Fire extinguishers were observed fully charged and last serviced on 06/09/2026. The facility has a sufficient supply of perishable and non-perishable food. No obstructions or hazards were observed inside or out.  Facility was observed to be clean and in good repair.

LPA reviewed four (4) resident records for appraisals, medical records, admissions agreement, consent forms. At approx 11:40 a.m., LPA resident records review of Resident #1's Physician's Report dated 07/24/2026 revealed that R1 has a prohibited health condition. R1 is not on hospice and no exception has been requested at this time.

Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training. All staff files were observed to be in order at this time.
Desaree Perera
Brian Balisi
DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2026
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: ANGELS II
FACILITY NUMBER: 565801215
VISIT DATE: 08/25/2026
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In addition the following was observed during the visit:

Stipulations posted on bulletin board in dining area.
Incident reports current and sent to regional office.
Medications properly stored inaccessible to residents in care.
Staff training's on facility protocols completed by staff and Administrators in May 2026.
Mental Health Assessments Training completed by staff and Administrators on 06/24/2026
Medications Training completed by staff and Administrators  on 06/27/2026.
Alzheimer's Disease Training parts 1 - 5 completed by staff and Administrators between 07/20/2026 to 07/23/2026
Alzheimer's Disease Training part 6 completed by staff and Administrators on 08/12/2026
Additional required training's will be completed  with Relias.

Licensee / Administrator completed Administrator Qualifications and Duties between 06/04 - 06/22.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Licensee was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed and a copy of this report and appeal rights were provided
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/25/2026 02:42 PM - It Cannot Be Edited


Created By: Brian Balisi On 08/25/2026 at 02:12 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: ANGELS II
FACILITY NUMBER: 565801215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2026
Section Cited
CCR
87615(a)(5)

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(a)Persons who require health services for or have a health condition including...(5)Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement is not met as evidenced by:
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Licensee agreed to work with R1's family on options to admit to hospice or apply for an exception. Licensee also agreed to review section cited and provide a written plan to ensure future compliance then send to LPA via email by POC date.
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Based on interview and record review, the facility did not comply with the above cited section, as R1 was retained in the facility with a prohibited health condition, which posed an immediate health and safety risk to persons in care.
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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.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Brian Balisi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2026


LIC809 (FAS) - (06/04)
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