195850435-6-5-2025-29-AS-ABAN-DHCTT3-20250605150004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850435
Report Date: 06/05/2025
Date Signed: 06/05/2025 03:00:54 PM

Document Has Been Signed on 06/05/2025 03:00 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:	TRUE LIVING CARE LLC		FACILITY NUMBER:	195850435
ADMINISTRATOR/ DIRECTOR:	HAVSGAARD, CHRISTIAN		FACILITY TYPE:	740
ADDRESS:	22740 HATTERAS STREET		TELEPHONE:	(951) 580-7888
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 6		CENSUS: 5	DATE:	06/05/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:10 PM
MET WITH:	Vanessa Havsgaard		TIME VISIT/ INSPECTION COMPLETED:	03:10 PM

NARRATIVE

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 12:10PM. LPA met with staff upon arrival and Administrator Vanessa Havsgaard. Entrance interview conducted.

At 12:15PM, the LPA along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN/LAUNDRY: The LPA inspected the kitchen/food service area at 12:15PM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked and inaccessible in kitchen drawer and cabinet under the sink. At 12:22PM, LPA observed one (1) milk carton that expired 06/03/2025 and five (5) sauces/condiments (maple syrup, two soy sauce bottles, ketchup, and oyster sauce) that were opened and stored in the pantry but state to “refrigerate after opening.” Administrator immediately discarded the expired milk and stored the sauces at appropriate temperatures. LPA observed a laundry room accessed through the kitchen which is locked and inaccessible to residents in care.

BEDROOMS: There are six (6) private resident bedrooms. There is one (1) staff bedroom that is being used by staff as a private living quarter. The staff room is accessed through an attached staff bathroom. All rooms have direct access to the outside. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, sufficient lighting, and 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: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

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: TRUE LIVING CARE LLC	FACILITY NUMBER: 195850435
	VISIT DATE: 06/05/2025

NARRATIVE

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RESTROOMS: There are five (5) full bathrooms; two (2) are private bathrooms for resident use and two (2) are full bathrooms in the hallway that are designated for residents, staff, and guests. LPA observed resident restrooms equipped with grab bars and slip-resistant surfaces. Between 12:26PM-12:33PM, hot water temperature was measured in resident bathrooms and were between 105.4-106.2 degrees F, which is within the required range.

COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The facility smoke alarm system is hard wired; the smoke and carbon monoxide detectors and fire doors were operable at the time of the visit. The fire extinguishers were fully charged and last serviced 12/06/2024. LPA observed required postings posted in the hallway and upon entry into the facility.

OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water on the premises. There is a self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. LPA observed a locked storage unit in the back yard containing additional supplies and yard equipment.

MEDICATION REVIEW: At 12:40PM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the medication room accessed through the kitchen/laundry. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. No errors observed during the medication review.

RECORD REVIEW: Beginning at 01:08PM, LPA reviewed five (5) out of five (5) resident files and three (3) personnel files for documents including but not limited to: medical records, resident Admission Agreement, TB test, staff training, first aid, and fingerprint clearance. All resident and personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/05/2025. All documents reviewed were updated and in compliance.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties.

Exit interview was conducted. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/05/2025 03:00 PM - It Cannot Be Edited

Created By: Angela Barutyan On 06/05/2025 at 02:39 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: TRUE LIVING CARE LLC	FACILITY NUMBER: 195850435
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87555(b)(23)

General Food Service Requirements

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as five (5) food items were not stored at appropriate temperatures which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2025
	Plan of Correction
1 2 3 4	Administrator stored food items at appropriate temperatures during the visit. Administrator stated they will conduct additional training with staff regarding food service requirements and will submit proof to CCL by 06/12/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

LIC809 (FAS) - (06/04)

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