565850244-6-8-2026-29-AS-BBAI-DUUSKF-20260608135640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850244
Report Date: 06/08/2026
Date Signed: 06/08/2026 01:57:06 PM

Document Has Been Signed on 06/08/2026 01:57 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:	PALS SKILLS CENTER		FACILITY NUMBER:	565850244
ADMINISTRATOR/ DIRECTOR:	POURAN MOUSAZADEH		FACILITY TYPE:	775
ADDRESS:	1310 E MAIN STREET		TELEPHONE:	(562) 489-3859
CITY:	SANTA PAULA	STATE: CA	ZIP CODE:	93060
CAPACITY: 30		CENSUS: 11	DATE:	06/08/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Jesus Landeros - Program Director		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced for a required one-year annual inspection today. Upon arrival, the LPA met with Program Director, Jesus Landeros and explained the reason for the visit. At approx 9:55 a.m., LPA along with the Program Director toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: The day program operates Monday through Friday from 8:00am to 2:00pm. There are (11) participants, and (16) program staff present today. The day program is currently staffed appropriately with the necessary staff to participant ratios. The facility is a single-story structure with a large conference room, two (2) calming/meeting rooms, one (1) relaxing/therapy room, one (1) computer area, one (1) meal area, one (1) staff room, two (2) small kitchens, and two (2) bathrooms. LPA did not observe any obstructions or hazards. Furniture and equipment was observed to be in good condition. LPA observed the kitchen/cafeteria area. Kitchen area was clean, and appliances appeared to be in operable condition. Participants bring their own lunch and snacks. The facility has snacks available for participants. Refrigerator and dry food pantry were checked for proper labels and expiration dates. LPA observed a sufficient supply of emergency food properly stored. Expiration dates were clearly marked at the time of the visit. LPA also observed (2) cabinets storing a sufficient amount of first aid and PPE properly stored. Activity rooms were observed to be furnished appropriately and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. LPA observed required postings throughout the common space. Activities are both designed for individuals and as a group. LPA observed staff interacting with participants during time of visit as well as preparing participants to go out to the community.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/08/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2026

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: PALS SKILLS CENTER	FACILITY NUMBER: 565850244
	VISIT DATE: 06/08/2026

NARRATIVE

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Equipment used for activities were observed to be in good condition at the time of the visit. Cleaning supplies were observed locked and inaccessible at the time of the visit. LPA observed several emergency duffle bags sufficiently stored. No obstructions or hazards were observed inside or out. LPA observed fire extinguishers fully charged and last serviced 06/11/2025. Landeros stated they are scheduled to be serviced this week. Smoke Detector / Carbon monoxide detectors are wired and operational at the time of the visit. Restrooms were clean and sanitary. The LPA observed trash cans with lids to protect participants from cross contamination. The bathrooms were sufficiently stocked with soap and paper towels. Hot water temperature was measured in participant restrooms, and they measured between 105 and 120 degrees Fahrenheit. There is a shaded area with appropriate furniture for participant use. The exterior passageways were clean and clear of any obstructions in case of an emergency. No bodies of water noted at the time of the visit.

Records review , Six (6) participant records were reviewed for the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, Individual Program Plans (IPP), and current needs and services plan. LPA reviewed six (6) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and valid first aid/CPR. Training records on file. Daily vehicle inspection list were reviewed for facility vehicles. All records were observed to be in order at this time.

Medication review, medications for all participants who receive medications were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review.

Infection control / Emergency Disaster plan: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Emergency disaster drills are conducted monthly; with the next one to be completed tomorrow 06/09/2026. During the visit LPA, obtained updated LIC 500, Census, Limited Liability Insurance, conducted interviews and updated Facility Administrator and contact information on file.

No citations issued during the visit. Exit interview conducted. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/08/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2026

LIC809 (FAS) - (06/04)

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