191290719-2-6-2026-31-AS-NSHN-DR33N7-20260206172329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290719
Report Date: 02/06/2026
Date Signed: 02/06/2026 05:23:40 PM

Document Has Been Signed on 02/06/2026 05:23 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MOTHER GERTRUDE HOME		FACILITY NUMBER:	191290719
ADMINISTRATOR/ DIRECTOR:	SR. ELIA CARO		FACILITY TYPE:	740
ADDRESS:	11320 LAUREL CANYON BLVD		TELEPHONE:	(818) 898-1546
CITY:	SAN FERNANDO	STATE: CA	ZIP CODE:	91340
CAPACITY: 97		CENSUS: 24	DATE:	02/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Sister Elia Caro - Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 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	On 02/06/2026 at approximately 11:30am, Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and met with Sister Elia Caro - Administrator. LPA explained the purpose of today’s visit. The Residential Care For Elderly (RCFE) facility has an approved fire clearance for thirty six (36) non-ambulatory and sixty one (61) ambulatory elderly adults 60 years old and above. Current census is twenty four (24) residents. The building is a two-story structure consisting of the RCFE area and a separate convent area for Franciscan Missionary Sisters of Immaculate Conception. Facility consists of the following: Resident suites with private bathrooms, public restrooms, staff rooms, administrative office, staff meeting room, lobby, a chapel, an activity room, a dining room, a kitchen, laundry room, medication room, inside patio and exterior courtyards. At 12:25pm LPA and Administrator toured the physical plant. Required postings were posted at the front entrance, lobby and office areas. Facility has multiple exists but uses the front entry as the main exit. There are multiple fully charged fire extinguishers throughout both floors of the facility. Fire extinguishers, smoke detectors/mono-oxide carbon detectors were all inspected by the Fire Department on 01/07/2026. In addition there are fire sprinklers throughout, including all the resident rooms. Disaster and fire drills are conducted quarterly, the last being completed on 12/03/2025. Entry/exit gates and pathways were free of obstruction. A raised fountain was observed in the inside patio area. There is an inside patio space for outdoor activities. The patio furniture includes chairs, benches, tables, umbrellas and three (3) swings, sufficient for number of residents. There is also a large gated courtyard with exit doors. Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MOTHER GERTRUDE HOME	FACILITY NUMBER: 191290719
	VISIT DATE: 02/06/2026

NARRATIVE

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Resident Rooms: The resident suites consist of two bedrooms and shared bathrooms for each bedroom. The bedrooms were randomly inspected for health and safety in both floors. Bedrooms were observed to have cabinets, dresser drawers, beds, chairs and adequate lighting. Bedrooms were clean and supplied with ample mattress, bedding/linens. LPA observed that a signal system is activated by a pull cord in each bathroom and bedroom. The signal system was tested in resident room 108A and in room 211A. In each instance staff responded to the signal within 2 minutes. LPA ensured that grab bars were properly installed in bathrooms and showers had non-skid mats. Bathrooms were clean and operational. Water temperature was measured at multiple rooms in both floors, ranging between 108.6 – 119.2 degrees Fahrenheit.

Kitchen/Dining Room: The facility has a commercial kitchen area that is equipped with two (2) commercial refrigerators, one (1) walking refrigerator, freezer, stove/oven, microwave oven. LPA also observed two (2) walking pantries. There was an adequate supply of non-perishable food items observed for (7 days) and (2 days) of perishable supplies. Kitchen is not accessible to residents, since sharp objects are kept locked in the kitchen. Dining room is furnished with multiple round tables, chairs and long tables for games and celebrations. There is also a piano, television set and musical area in the dining room for musical performances.

Laundry Room: LPA observed three (3) regular size washing machines and two (2) regular dryers, two (2) commercial sized washers and two (2) commercial dryers in the laundry room. Detergents and cleaning supplies were locked near the appliances. Laundry room is quite large and has storage space. In addition there is a small bathroom for staff use, in the laundry room.

Medications/Records: LPA observed that medications were locked in the Medication Room with proper labels for each resident. Medications were counted in random and compared for accuracy of administration, based on physician orders. Resident records for five (5) residents were reviewed for completion of required documents. At 3:20pm LPA conducted an audit of six (6) staff files to ensure all trainings and records are complete. The facility is current in CCLD annual fees. The Administrator certificate is valid through 03/23/2028. The facility has a current liability insurance effective 11/04/2025 through 11/04/2026.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no immediate health and safety hazards were observed at the time of this inspection. No deficiencies were cited.
Exit Interview Conducted / A Copy of the Report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

LIC809 (FAS) - (06/04)

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