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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801331
Report Date: 12/30/2025
Date Signed: 12/31/2025 08:39:35 AM

Document Has Been Signed on 12/31/2025 08:39 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:STONEHENGEFACILITY NUMBER:
565801331
ADMINISTRATOR/
DIRECTOR:		MCKIAN NIELSENFACILITY TYPE:
735
ADDRESS:1758 SOUTH LEWIS ROADTELEPHONE:
(805) 383-3669
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 15CENSUS: 15DATE:
12/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Nielsen McKainTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valeria Conway conducted a required annual inspection today at 9:30 A.M. The LPA met with Administrator McKian Nielsen and the reason for the visit was explained. Entrance interview conducted.

At 9:40 A.M., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The facility is equipped with two separate kitchens. Both kitchens were equipped with fixtures and appliances that appeared clean and functional. The first kitchen observed is for resident use. The refrigerator was observed with resident’s snacks and leftovers. The second kitchen is for staff use and daily cooking. There was an adequate supply of perishable and nonperishable foods. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. Knives and sharps were observed in a locked pantry at the time of the visit.

BEDROOMS and BATHROOMS: There were 15 bedrooms designated for resident use. Each resident bedroom includes an individual half bathroom. LPA observed seven (7) randomly selected bedrooms including the half bathroom. Bedrooms were observed to be designated for single occupancy and were properly furnished, including adequate supplies of bedding and linen, with sufficient lighting. All bathrooms observed were adequately supplied with required paper products and soap.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2025
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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Document Has Been Signed on 12/31/2025 08:39 AM - It Cannot Be Edited


Created By: Valeria Conway On 12/30/2025 at 11:07 AM
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: STONEHENGE
FACILITY NUMBER: 565801331

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80070(C)
(c) All information and records obtained from or regarding clients shall be confidential.

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 as records for former discharged clients were observed stored in an unlocked closet that is also used to store emergency food supplies which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2026
Plan of Correction
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Administrator to immediately remove all client files from the hallway closet and store them in a secure, locked file cabinet designated for confidential records. In addition, the Administrator will submit a photo to the LPA verifying that the emergency food closet is free of client files. Administrator agreed to conduct an in-service training with all staff names and procedures for handling and storing client files and submitting documentation to LPA before POC due date.
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.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 12/31/2025 08:39 AM - It Cannot Be Edited


Created By: Valeria Conway On 12/30/2025 at 02:30 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: STONEHENGE
FACILITY NUMBER: 565801331

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85095.5(a)(2)(A)
Infection Control Requirements
(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products.  These activities shall be completed, at a minimum, as follows:  (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary.  These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. 

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 by having client rooms in an unsanitary condiction which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/14/2026
Plan of Correction
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Administrator will immediately implement a strict cleaning and disinfection protocol for all client bedrooms and bathrooms. Administrator will establish and enforce a staff cleaning schedule to ensure ongoing cleanliness and compliance with infection control requirements. A photo documentation of the cleaned client rooms and bathroom will be submitted to the LPA prior to the due date.
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, the licensee did not comply with the section cited above as toilet in Room #1 is out of service and several rooms had a broken towel holder which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2026
Plan of Correction
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During today's visit, a work order was created to repair the broken toilet. The administrator will notify the LPA of the estimated repair date. Toilet shall be fixed by next week. Upon completion of the repair, video showing the toilet is in proper working condition will be submitted to the LPA. In addition, staff will inspect all client rooms to ensure that towel holders are in good repair. Any identified broken holders will be fixed and a list will be sent to LPA before 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.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/31/2025 08:39 AM - It Cannot Be Edited


Created By: Valeria Conway On 12/30/2025 at 02:30 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: STONEHENGE
FACILITY NUMBER: 565801331

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85165(f)(7)
Emergency Intervention Staff Training
(f) The administrator who will approve the continued use of a manual restraint or seclusion shall complete additional training which shall include the following: (7) Current first aid certification and current certification in the use of cardiopulmonary resuscitation (CPR).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by having direct care staff with an expired CPR certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2026
Plan of Correction
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The administrator agreed to ensure that all staff obtain current CPR certification. Proof of CPR certification for all staff will be submitted to the LPA prior to the assigned due date.
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.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2025


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: STONEHENGE
FACILITY NUMBER: 565801331
VISIT DATE: 12/30/2025
NARRATIVE
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Continued from LIC 809

However, LPA observed that bathroom countertops, floors and walls were visible stained. Additionally, the toilet in Room #6 was observed to be soiled with body fluids. The administrator stated that staff are required to conduct a deep cleaning every Sunday. Furthermore, LPA observed a broken toilet in Room #1 and missing towel holders in Room #1 and Room #4. Between 9:53 A.M. and 10:19 A.M., the hot water temperature was measured in all selected bathrooms, and they measured within the regulatory range.

SHOWER ROOMS: The LPA observed two (2) small showers and two (2) large showers. Fixtures were observed to be functional at the time of the visit.

COMMON AREAS: Common areas include two (2) dining areas and two (2) living rooms. All common areas were adequately furnished for resident use. There is also a laundry room, which residents utilize. Staff provide cleaning detergent upon request. All hazardous cleaning chemicals were observed to be stored, locked, and inaccessible to residents at the time of the visit. Additional clean linens were observed for resident use. LPA observed a complete first aid kit inside the staff bathroom. Facility has an ample supply of emergency water at the time of the visit. Emergency food is stored inside an unlocked hallway closet. During today’s visit, LPA observed records for former discharged clients. Carbon monoxide detectors were tested and operational at the time of the visit. Several fire extinguishers were observed throughout the facility and were fully charged and last serviced on 11/19/2025.

SURROUNDING GROUNDS: There are several shaded areas with adequate furniture for residents’ use.

MEDICATIONS: At approximately 11:15 A.M. a medication review for five (5) randomly selected residents was conducted. Medications are stored inside the staff office in a locked cabinet. All medications reviewed were stored and documented per regulation.

Continued on LIC 809-C

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

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: STONEHENGE
FACILITY NUMBER: 565801331
VISIT DATE: 12/30/2025
NARRATIVE
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Continued from LIC 809-C

RECORD REVIEW: LPA reviewed Clients Records at 12:15 P.M. and Personnel Records at 1:25 P.M. Seven (7) client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All records reviewed were complete. Five (5) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Four (4) out of five (5) staff did not have first aid/CPR certificate on file.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as they pertain to infection control are adequate. LPA also reviewed the facility's emergency disaster plan. Emergency disaster drills are conducted at least quarterly for each shift. The administrator presented documentation of the most recent emergency drills for each shift and they were conducted within the last three (3) months respectively.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Administrator 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: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC809 (FAS) - (06/04)
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