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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801589
Report Date: 01/12/2026
Date Signed: 01/12/2026 02:14:38 PM

Document Has Been Signed on 01/12/2026 02:14 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:FAMILYCARE COTTAGE IIFACILITY NUMBER:
565801589
ADMINISTRATOR/
DIRECTOR:		DEBRA BRYANTFACILITY TYPE:
740
ADDRESS:389 RAMBLE RIDGE DR.TELEPHONE:
(805) 492-1200
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 4DATE:
01/12/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:46 AM
MET WITH:Magdalena Garcia - Assistant Administrator
Marisol Flamenco - Administrator 		TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Erica Mosley conducted a Case Management - Incident visit to follow up on a self-reported incident which took place on 1/4/2026. At 9:46 a.m. LPA Mosley was greeted by staff who called the Administrator. LPA met with Marisol Flamenco, Administrator and Magdalena Garcia, Assistant Administrator and the reason for the visit was explained. Entrance interview.

On 01/04/2026 it was reported that at approx. 3:20 p.m. Staff #1 (S1) called the Administrator to inform them that it has been about 15 minutes and Staff #2 (S2) has not yet shown up to their scheduled shift and they had to leave. At that time the Assistant Administrator made calls to find coverage and Administrator was less than 15 minutes away and drove to the facility. Once the Administrator arrived to the facility at approx 3:35 p.m. they noted seeing S1 on their bike two (2) houses down. The Administrator immediately checked on the welfare and well-being of the residents, no injuries or incidents were noted. The Administrator called Licensing leaving a voicemail briefly informing them of the incident and request a call back. Subsequently S1 was terminated for not following the facility policy : Residents Must Not Be Left Unattended and all staff received an in service training regarding the same policy.

During today's visit, from 9:50 a.m. LPA and staff conducted a physical plant tour to ensure there were no immediate health and safety concerns. Starting at 10:00 a.m and throughout the visit LPA conducted four (4) in person staff interviews including the Assistant Administrator and Administrator, four (4) resident interviews and record review along with obtained copies of pertinent documents relevant to the incident.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2026
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FAMILYCARE COTTAGE II
FACILITY NUMBER: 565801589
VISIT DATE: 01/12/2026
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Report Continued from LIC 809...

Interviews with the staff revealed that they are not allowed to leave the residents unattended. If a staff is running late they must notify administrative staff immediately. The administrative staff typically find coverage relatively fast. They were not present on the incident date of 01/04/2026. They recently received an in service training regarding the facility policy : Residents Must Not Be Left Unattended.

Interview with the Administrator revealed that on the day of the incident, 01/04/2026 they received a call from S1 informing them that S2 has not yet arrived for their shift and that they had to leave. The Administrator called the Assistant Administrator to get a hold of S2 and being finding coverage while they drove to the facility with the intention to relieve S1. They were about 13 minutes away from the facility and when they arrived they saw S1 on their bike two (2) houses down. They immediately checked on all the residents safety and well being, no injuries or incidents were observed or noted. It was noted that all five (5) residents at the time were on the couch in the living room, watching the television.

Interviews with the residents revealed that they were unaware of being unattended. To their knowledge they are never left unattended and staff are always available to them. They are happy with the care they are provided and no concerns were noted or voiced.

Record review and interviews support that there has not been any past incidents related to supervision. In service training was conducted from 01/08/2026 - 01/11/2026 to cover all shifts on the facility policy: Residents Must Not Be Left Unattended with a signed statement of acknowledgment from all staff. Guardian background check system revealed that S1 was separated from the facility roster on 01/04/2026. Personnel report - LIC 500 dated 01/06/2026 does not list S1.

No deficiencies were cited at this time. Exit interview conducted. Report was reviewed and a copy was provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026
LIC809 (FAS) - (06/04)
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