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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802554
Report Date: 06/26/2026
Date Signed: 06/26/2026 01:52:20 PM

Document Has Been Signed on 06/26/2026 01:52 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:E3 WELLNESS CENTERFACILITY NUMBER:
565802554
ADMINISTRATOR/
DIRECTOR:		STEPHEN ROMEROFACILITY TYPE:
775
ADDRESS:2585-2587 TELLER ROADTELEPHONE:
(805) 375-9222
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY: 45CENSUS: 43DATE:
06/26/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Stephen RomeroTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:40AM. LPA met with staff and Administrator Stephen Romero and explained the reason for the visit.

Beginning at 10:50AM, 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:

The facility is a single-story structure with three (3) activity rooms, two (2) conference rooms, three (3) bathrooms, a large staff room, a food service area, and an exercise area. The day program is operating its normal hours from 8:30AM to 2:30PM.

COMMON AREAS: The LPA observed the conference rooms and entrance area to be relatively clean and properly furnished. The LPA observed the food service area and staff room. Cleaning solutions, toxins, chemicals and other hazardous items were inaccessible and locked away underneath the kitchen sink. Clients use the refrigerator to store their lunches. Additional cleaning supplies are located in a locked storage room. The LPA observed sufficient drinking water. No obstructions or hazards were observed inside or out. Equipment used for activities was observed to be in good condition. LPA observed offices and activity rooms which were observed to have appropriate furniture and supplies. Inside temperature was maintained at a comfortable level.

Report Continued on LIC809-C.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2026
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: E3 WELLNESS CENTER
FACILITY NUMBER: 565802554
VISIT DATE: 06/26/2026
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RESTROOMS: LPA inspected three (3) client restrooms. Restrooms were clean and sanitary and in operating condition. The sink had sufficient liquid soap, and paper towels. The hot water temperature was tested and measured between 108.0-109.6 degrees Fahrenheit, which is within the required range.

MEDICATION REVIEW: Medications are centrally stored and locked. Facility staff handle medications for three (3) clients. The facility is using a MAR and maintains a centrally stored form, which was complete. Starting at 11:17AM, the LPA conducted a review of medication and medication documentation with the Administrator for the three (3) clients and observed that medications were properly documented and assisted as prescribed.

RECORD REVIEW: Beginning at 11:40AM, LPA conducted a file review for six (6) clients and five (5) staff for documents including but not limited to: Individual Programming Plan (IPP), Individual Service Plan (ISP), medical assessments, admissions agreement, staff training, first aid/CPR, health assessments, and criminal record clearances. LPA observed three (3) out of six (6) client files with incomplete medical assessments that were missing physician’s signatures or client names. Administrator stated they will obtain complete medical assessments. Staff files reviewed were complete and in order.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, the LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. LPA observed the fire extinguishers to be fully charged and last serviced on 01/15/2026. Smoke and carbon monoxide detectors are hardwired and tested by Elite Fire Pros. The last fire inspection was completed on 02/04/2026 and the facility was found to be in compliance with Fire Code Regulations at the time of inspection. Emergency disaster drills are conducted semi-annually, with the last documented drill on 01/07/2026. LPA informed Administrator that disaster drills shall be conducted quarterly.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties.

Exit interview was conducted. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2026 01:52 PM - It Cannot Be Edited


Created By: Angela Barutyan On 06/26/2026 at 01:35 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: E3 WELLNESS CENTER
FACILITY NUMBER: 565802554

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)
Client Medical Assessments
(b) The medical assessment shall include the following:

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 as three (3) out of six (6) client files reviewed had incomplete medical assessments. Two (2) were missing signatures and dates from the physician(s) and one (1) was missing the client's name. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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Administrator stated they will obtain complete medical assessments for the three clients and will submit proof to CCL by the 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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2026


LIC809 (FAS) - (06/04)
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