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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850091
Report Date: 07/25/2025
Date Signed: 07/25/2025 04:43:30 PM

Document Has Been Signed on 07/25/2025 04:43 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:PRESERVE AT WOODLAND HILLS, THEFACILITY NUMBER:
195850091
ADMINISTRATOR/
DIRECTOR:		SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:6221 FALLBROOK AVENUETELEPHONE:
(747) 226-5834
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 60CENSUS: 47DATE:
07/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Susan Weisbarth - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Quoc Huynh and Angela Barutyan arrived unannounced at 9:55AM for a required one year visit. The LPAs met with Health and Services Director (HSD) Tony Nunez and Executive Director (ED) Susan Weisbarth and explained the reason for the visit. Entrance interview conducted.

At 10:30AM, the LPAs and HSD 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. The following was observed:

KITCHEN: The facility’s kitchen was inspected and found to be in compliance with Title 22 regulations. The facility receives food deliveries four (4) times a week from different vendors. There was a sufficient supply of perishable and non-perishable food. The food in the freezer and the refrigerator were observed to be of good quality.

COMMON AREAS: The facility is a one-story building that contained a lobby, offices, kitchen, storage, and employee lounge which was inaccessible to residents. The remainder of the facility had a dining room, activity room, day room, activity office, salon, medication room, and an outdoor courtyard. The LPAs observed common areas to be clean and in good condition. There were no obstructions and/or tripping hazards throughout the facility. Areas that posed a safety risk to residents were observed to be locked.

Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2025
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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Document Has Been Signed on 07/25/2025 04:43 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/25/2025 at 03:54 PM
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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 5 out of 6 resident restroom sink water did not measure within the required range which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2025
Plan of Correction
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Staff will adjust water temperature and test water temperatures for 5 days and submit CCLD the logs by POC due date.
Type A
Section Cited
CCR
87303(i)
Maintenance and Operation
(i) Facilities shall have signal systems which shall meet the following criteria:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in the facility did not have a call ssystem in resident rooms and bathrooms which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2025
Plan of Correction
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Staff will inquire a third party vendor and receive a quote or service request and send CCLD proof by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/25/2025 04:43 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/25/2025 at 03:54 PM
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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(b)
Storage Space and Access
(b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 residents had access to items their Physician deemed as at risk which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2025
Plan of Correction
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The Health and Services Director (HSD) secured R3's razors during the visit. The Executive Director and HSD will secure the cleaning supplies located under R1's restroom sink and send CCLD proof by POC due date.
Type A
Section Cited
CCR
87464(f)(1)
(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, record review, and observation, the licensee did not comply with the section cited above as staff did not respond to residents calls for assistance in a timely manner, which poses a potential health, safety, and personal rights risk to persons in care.
POC Due Date: 07/26/2025
Plan of Correction
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The Executive Director will conduct an in service training with all Staff to address Staff's response time to resident's needs. The Executive Director will send CCLD a statement of understanding with Staff signatures by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2025


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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 07/25/2025
NARRATIVE
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Required postings were found in the lobby and throughout the facility hallways. There were fire extinguishers throughout the facility, which were serviced 04/28/2025 and contained emergency flashlights.

The courtyard contained a raised garden bed, activities for residents, and furniture in good condition with shade. Emergency food and water were stored in an outdoor utility closet along with general storage. The LPAs also observed the emergency side exits. In the rear of the facility, the LPAs, ED, and HSD observed a window screen leaning against the building that belonged to a resident’s window above it. The ED and HSD identified the resident’s unit and had maintenance secure the window screen onto the window.

RESIDENT ROOMS: Beginning at 10:40AM, the LPAs observed ten (10) randomly selected resident rooms. Appropriate furniture and sufficient lighting were observed in the units. The LPAs did not observe signal systems installed in the resident rooms. The HSD stated that resident rooms were equipped with motion sensors that detect resident movement and potential falls, however, no system is in place for residents to call for help from their room. LPAs observed some residents wearing pendant buttons which transmit signals to the facility laptop. The HSD stated that not every resident gets a pendant. The pendants currently being used identify which resident enacted the call. At 12:30PM, the LPAs and HSD tested three (3) randomly selected pendant buttons which were not operational at the time as there were no signals received by the laptop. One (1) of the pendants flashed a red light indicating it was not operational. Staff interviews revealed that response times to pendant calls have been an issue at the facility and staff have gotten multiple warnings and in-service training to improve response times. Interviews with two (2) residents revealed concerns of the facility’s signal system and staff response times. LPAs reviewed call logs for Resident #1 (R1) between 07/01/2025-07/25/2025 and observed response times ranging from 6 minutes to 2 days. There were seventy-six (76) calls total, of which fifteen (15) were accidental repeat calls by R1, making a total of sixty-one (61) calls by R1. Call logs revealed only ten (10) out of sixty-one (61) pendant calls had response times under fifteen minutes.

Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 07/25/2025
NARRATIVE
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Resident restrooms were clean, with properly installed grab-bars in resident bathrooms and non-skid strips in shower tubs. Water temperature was tested throughout the units and measured between 95 degrees F and 128.5 degrees F, which is not within the required range per regulation. R1 was observed to have cleaning supplies stored under their restroom sink which included disinfectants, bathroom foam cleaner, and multi-purpose cleaner. Resident #2’s (R2) restroom vanity handle on the right bottom cabinet was observed to need repairs. The HSD stated they would check in with the facility’s maintenance to have it repaired. Resident #3 (R3) was observed to have oxygen administered and did not have signage outside their unit. The HSD confirmed R3 was receiving oxygen and had facility Staff post the signage. Resident #4 (R4) had access to two (2) electric razors in their restroom, which the HSD and ED secured during the visit. Record review revealed R1 and R3 were at risk and should not have access to these items. R3’s Physician’s Report specifically identifies R3 should not have access to razors.

MEDICATION: Medication review began at 12:11PM. The LPAs reviewed medications for five (5) residents. Medications were inaccessible in locked medication carts and in the medication room. Five (5) out of five (5) resident medications reviewed were documented and stored in compliance with regulation at this time.

RESIDENT RECORDS: Resident records were reviewed at 3:25PM. The LPAs reviewed five (5) files for, but not limited to: admissions agreements, medical assessments, and appraisals. Resident records reviewed were in order at this time.

Due to time constraints the annual visit will continue at a later date.

Three (3) Staff and five (5) residents were interviewed. No complaints noted.

Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D).

The ED designated the HSD to sign today's report. Exit interview conducted. A copy of the report and appeal rights were reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
LIC809 (FAS) - (06/04)
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