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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801923
Report Date: 07/07/2025
Date Signed: 07/07/2025 03:05:33 PM

Document Has Been Signed on 07/07/2025 03:05 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:ABUTIN CARE HOME IFACILITY NUMBER:
565801923
ADMINISTRATOR/
DIRECTOR:		JOYCE ABUTINFACILITY TYPE:
735
ADDRESS:603 E. IRIS STREETTELEPHONE:
(805) 240-0095
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 5DATE:
07/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Benjamin AbutinTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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At 10:35 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced Required - 1 Year inspection at the facility listed above. When the LPA arrived, there was only one staff present as all the clients were at their day programs. The LPA met with Co-Administrator Benjamin “Ben” Abutin and explained the reason for the visit. This home is vendored by Tri-Counties Regional Center as a level three (3) home. Administrator, Joyce Abutin, was contacted by phone and the reason for this visit was explained.

The LPA and the co-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:

Fire Extinguisher was observed to be fully charged and purchased on 06/04/2025. Hardwired smoke detectors and carbon monoxide detectors were tested at 10:52 A.M. and were functional at the time of the visit

BEDROOMS: There are three (3) shared client bedrooms and one staff bedroom. Staff room was observed locked. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: The facility has two (2) common restrooms for client and staff use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. Between 10:50 A.M. and 11:02 A.M. the hot water temperature in both restrooms measured between regulation range of 105-120 degrees Fahrenheit.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2025
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: ABUTIN CARE HOME I
FACILITY NUMBER: 565801923
VISIT DATE: 07/07/2025
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Continued from LIC 809-C

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and condition. All indoor and outdoor passages were free of obstruction. At the time of the visit, living room and dining room furniture was observed to be in good condition. Medications are centrally stored and in a locked cabinet in the dinning room. LPA observed a ring doorbell, co-administrator did not know that a waiver is required to have ring doorbell due to the audio component. LPA did not cite but advised the licensee to submit a waiver for the Ring doorbell due to the audio component, to update plan of operation and admission agreement or to turn off the audio setting for privacy.

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives, cleaning supplies and items that could pose a danger were observed to be locked and secured at the time of the visit. At 10:46 A.M. hot water temperature measured at 111.4 degrees Fahrenheit. Cleaning compounds were locked under the kitchen sink and separately from food supplies.



LAUNDRY ROOM/GARAGE: The washer and dryer were observed in good conditions. LPA observed extra can goods, cleaning supplies and disinfectants kept in cabinets surrounding the washer. The dryer is in the garage. Extra food items, emergency food and emergency water was observed in the garage.

OUTDOOR SPACE: The backyard area contains a shaded area with a table and chairs for client use. There is a side gate with self-closing and self-latching mechanisms. Passageways were observed to be clear and free of hazards. There were no bodies of water noted.

Continued on LIC 809-C

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

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ABUTIN CARE HOME I
FACILITY NUMBER: 565801923
VISIT DATE: 07/07/2025
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Continued from LIC 809-C

RECORDS: Between 11:15 A.M. and 12:25 P.M. review of facility files was conducted. Facility records are stored in a locked cabinet in the living area. The LPA observed documentation of Infection Control, Disaster prevention and last emergency drill (conducted on 06/24/2025). LPA observed that the Emergency and disaster drill was not annually updated. Technical violation (TV) issued. The LPA reviewed P&I money and records with the Co-Administrator. Cash resources for all five (5) clients were separate and intact and not commingled with facility funds or petty cash. The facility has a current surety bond on file. The five (5) client files reviewed were found to be complete. Seven (7) staff files were reviewed and also found to be complete.

MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the dining room area. At 12:29 P.M. medications for all clients were reviewed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. The LPA inspected the first aid kit, which was complete.

INTERVIEWS: Interviews with one staff was conducted. No issues or concerns revealed.

No deficiencies were cited during today's inspection. Exit interview and reported reviewed with the Co-Administrator. A copy of the report was provided.

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

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4