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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609713
Report Date: 11/10/2025
Date Signed: 11/10/2025 06:45:58 PM

Document Has Been Signed on 11/10/2025 06:45 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:SAUNDRA JARMON'S BOARD AND CAREFACILITY NUMBER:
567609713
ADMINISTRATOR/
DIRECTOR:		JARMON, SAUNDRAFACILITY TYPE:
735
ADDRESS:3541 KETCH AVETELEPHONE:
(805) 985-1772
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY: 6CENSUS: 2DATE:
11/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Saundra JarmonTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit and entered the facility at 4:00 p.m. Upon arrival, LPA Cortez was greeted by Administrator / Licensee Saundra Jaemon and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and freezer were inspected. Knives and sharps were observed locked in a staff room adjacent to the kitchen. Cleaning supplies and items that could pose a danger were secured in locked cabinet in the garage.

COMMON SPACES/ BACKYARD/ GARAGE: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture appear to be in good condition. The fire extinguishers appeared to be fully charged and were last inspected 09/08/2025. The smoke and carbon monoxide detectors were tested and functioned properly during the visit. The last emergency disaster drill took place on 10/13/2025 and conducted quarterly. There is a washer and dryer on the premises. The facility has a sufficient supply of emergency food and water located in the garage. Cleaning supplies and items that could pose a danger were secured in locked cabinet in the garage. There is an open office which contains records that remain locked at all times in filing cabinets. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gate. There were no bodies of water noted at the time of the visit. Report will continue on LIC 809-C, 2nd page....

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Esther Cortez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2025
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: SAUNDRA JARMON'S BOARD AND CARE
FACILITY NUMBER: 567609713
VISIT DATE: 11/10/2025
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RESTROOMS: The facility has three (3) restrooms. One (1) is designated as private client restroom, one (1) is designated as a shared restroom, and one (1) as a staff restroom. All client restrooms were clean and sanitary with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in the common restroom was measured at 116.7 F.

BEDROOMS: There are four (4) total bedrooms. Three (3) are designated as client bedrooms; All Three (3) are designated as shared double-occupancy bedrooms, however only two client rooms are currently occupied. One (1) is designated as a staff room which remains locked at all times. LPA observed all client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There was a linen closet in the hallway with extra towels and linens.

RECORDS: Record review was initiated. The LPA observed documentation of Infection Control, Emergency and Disaster Plan, and Insurance Liability. The LPA reviewed two of two client records and the following was observed: Both clients did not have updated appraisal/needs and service plans on file. Upon observation the administrator stated that they had recently done them and did not know why they were not in their files, however will send new ones to LPA. The LPA also observed that one client did not have a negative TB test on file. The two (2) clients currently do not have the facility managing or safeguarding their cash resources. Clients handle their own finances and cash resources. The LPA reviewed three of three staff files, all documents were complete.

MEDICATIONS: Medications review was conducted. The medications are locked in a cabinet adjacent to the kitchen near the backyard exit. Medications for two (2) clients were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records.

INTERVIEWS: Two (2) clients and one (1) staff interview were conducted. No concerns voiced.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Esther Cortez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC809 (FAS) - (06/04)
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