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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850302
Report Date: 08/25/2025
Date Signed: 08/25/2025 12:20:00 PM

Document Has Been Signed on 08/25/2025 12:20 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: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:
08/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Katherine Bergerson "Kari Wood"TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced at 11:05AM to conduct a required annual visit. The facility did not have any clients or staff on site upon arrival. LPA spoke with Director of Care Compliance Taylor Stead telephonically at 11:10AM. LPA met with Administrator and Clinical Director of Operations Katherine Bergerson “Kari Wood” at 11:22AM and explained the reason for the visit.

Beginning at 11:24AM, 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. The following was observed:

Fire extinguishers were fully charged and were last serviced 02/24/2025. Hardwired smoke and carbon monoxide detectors were tested at 11:47AM 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 an adequately screened fireplace. Bedroom #2 has an exit to the exterior and is equipped with functioning auditory exit alarms. Report continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2025
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: LIGHTFULLY - HALO
FACILITY NUMBER: 565850302
VISIT DATE: 08/25/2025
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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 and equipped with slip-resistant surfaces. The hot water temperatures were measured to be between 112.5-113.9 degrees Fahrenheit, which is within the required range. At 11:27AM, LPA observed the hot water faucet handle in the main bathroom in disrepair. The handle required significant force to turn on the hot water. LPA informed Administrator that the handle shall be repaired prior to admitting clients.

KITCHEN: LPA inspected the kitchen at 11:35AM. Knives and sharps were stored in locked drawers. Kitchen appliances were in operable condition. LPA did not observe perishable food at the facility as there are no clients currently residing at the facility. At 11:38AM, LPA observed the kitchen window screen on the ground outside. LPA informed Administrator that the window screen shall be installed and repaired prior to admitting clients.

MEDICATIONS: Medications will be kept locked and inaccessible in a medication cart in the nursing office. LPA observed a medication refrigerator that can store medications locked and inaccessible.

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 net cover. All exterior passageways were clear and free of obstructions. LPA observed gates to self-latch.

No citations issued. Exit interview conducted and a copy of the report was provided.

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

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
LIC809 (FAS) - (06/04)
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