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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850302
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:53:34 AM

Document Has Been Signed on 09/05/2024 11:53 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:LIGHTFULLY - HALOFACILITY NUMBER:
565850302
ADMINISTRATOR/
DIRECTOR:		YVETTE LLANOSFACILITY TYPE:
772
ADDRESS:949 EL SEGUNDO DRIVETELEPHONE:
(805) 852-5457
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 6CENSUS: 0DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Deanna WoodhouseTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility announced at 09:38AM to conduct a required annual visit. The facility did not have any clients or staff on site upon arrival. LPA spoke with Director of Clinical Operations Yvette Llanos and Director of Care Compliance Taylor Stead telephonically between 09:50AM-10:08AM. LPA met with Administrator and Program Director Deanna Woodhouse at 10:22AM and explained the reason for the visit.

Beginning at 10:23AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. LPA was only able to conduct a physical plant tour for today’s visit as the facility currently does not have admitted clients and has never admitted any in the past. The following was observed:

Fire extinguishers are fully charged and were last serviced 01/12/2024. Hardwired smoke and carbon monoxide detectors were tested at 10:51AM and all were functional at the time of the visit.

COMMON AREAS: This includes the group therapy room, kitchen, formal dining room, family room, nursing office, therapy office, and staff office in the converted garage. The common areas were appropriately furnished, and the lighting was adequate. The facility has a central entry point for symptom screening and sanitation station for staff, clients, and visitors. LPA observed fireplaces in common areas that are properly screened. Cleaning supplies and hygiene items are stored in a locked cabinet in the hallway. Facility had a sufficient supply of towels and linens. Emergency exiting plans/sketch were posted throughout the facility.

BEDROOMS: There are three (3) bedrooms designated for shared-client use. Each bedroom has two beds, night stands, chairs, and lights. Bedroom #1 has a screened fireplace.

Report continued on LIC 809-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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Document Has Been Signed on 09/05/2024 11:53 AM - It Cannot Be Edited


Created By: Angela Barutyan On 09/05/2024 at 11:26 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: LIGHTFULLY - HALO
FACILITY NUMBER: 565850302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81087(c)
Buildings and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that east-side exterior exit passageway is obstructed which poses a potential health and safety risk to persons in care.
POC Due Date: 09/20/2024
Plan of Correction
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Administrator agrees to sand down the east-side exit door or replace it so that it no longer gets stuck to the ground and can be opened or closed without force.
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.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angela Barutyan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


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: LIGHTFULLY - HALO
FACILITY NUMBER: 565850302
VISIT DATE: 09/05/2024
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RESTROOMS: The facility has four (4) restrooms of which one (1) is a private restroom attached to Bedroom #1, two (2) are adjacent to client bedrooms in the hallway, and one (1) is a common restroom by the facility entrance. Restrooms were observed to be clean and sanitary with hand soap, paper towels, and toilet paper. The hot water temperature in all four (4) restrooms were measured between 117.0 – 117.6 degrees Fahrenheit between 10:25AM-10:35AM.

MEDICATIONS: Medications will be kept locked and inaccessible in a medication cart in the nursing office.

GROUNDS: There is a covered area in the backyard with furniture including a table and chairs and a screened fireplace. The backyard area has a pool and jacuzzi that is inaccessible to clients by a pool cover. The exit door for the east-side exterior passageway is too large and is not able to be opened or closed without force as it gets stuck to the ground and causes obstruction.

Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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