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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605806
Report Date: 11/24/2025
Date Signed: 11/24/2025 04:37:35 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/24/2025 04:37 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:LAS CASITAS ASSISTED LIVINGFACILITY NUMBER:
197605806
ADMINISTRATOR/
DIRECTOR:		NATALIE GONZALEZFACILITY TYPE:
740
ADDRESS:1633-1645 N. HOLLYWOOD WAYTELEPHONE:
(818) 238-9951
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 17CENSUS: 12DATE:
11/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Patricia Duran De Garcia - House ManagerTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Patricia Duran De Garcia - House Manager and explained the reason for the visit. LPA spoke with Administrator Natalie Gonzalez over the telephone, who stated that she can not visit the facility today but designated Patricia Duran De Garcia- House Manager to sign the report.

The facility is licensed to serve 17 non-ambulatory residents over the age of 60 with an approved hospice waiver for 2 residents. The facility is comprised of (6) single story cottages (casitas), each with (2) bedrooms and (1) bathroom and small living room and kitchenette. The common areas include a dining room, kitchen, TV/living area, activity /music room, staff bathroom in living area, (3) office spaces and a central courtyard area.

At approximately 10:15am, with the assistance of House Manager, LPA conducted a facility tour and observed the following:

The entrance is gated and kept locked from the outside, visitors are allowed in by ringing the door bell. Upon entering the front gate and upon exiting from the back gate, LPA observed functional auditory alarms being heard. There are cameras in front and back of the facility. During emergencies facility uses the back alley exit for evacuation. Smoke detector and monoxide carbon detectors are interconnected and there are fire sprinklers in common areas. There are two fire extinguishers located in the kitchen and four in the central courtyard. All fire extinguishers are fully charged with a charge date of 07/29/2025. The last fire and emergency drill was conducted on 10/01/2025.

Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2025
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAS CASITAS ASSISTED LIVING
FACILITY NUMBER: 197605806
VISIT DATE: 11/24/2025
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Bedrooms/Bathrooms: All the bedrooms were furnished with different style but all rooms had required beds, chairs, closets, dresser drawers and linens. Bedrooms # 35 and #39 are currently vacant. There is one shared bathroom in each cottage. All bathrooms had required non-skid mats, grab bars, liquid soap and paper towels. At 11/38am LPA pulled the cord in bedroom # 35 and wihtin 2 minutes staff came for assistance. Water temperature in four bathrooms were measured and hot water temperature measured between 108.1 °F. and 119.1°F; within the required range.

Kitchen: All kitchen appliances and surfaces were clean and sanitary. The sharp objects were locked in a cabinet. The pantry and the refrigerator were supplied with a sufficient supply of perishable (2 days) and non-perishable (7 days) foods. LPA observed several expired containers of tomato sauce in the pantry; citation will be provided.

Garage: There is an unoperable car in the garage. There are multiple cabinets and shelves for storing supplies and there is a refrigerator and freezer with food supplies. There are two laundry washers and two dryers in the garage and all detergents and chemicals are locked, inaccessible to residents.

Medications: LPA observed the medications in a locked cabinet in the office, located by the kitchen. Medications for six (6) residents were counted and verified that medication were properly administered. LPA observed the medications removed from original containers and stored in weekly medicine boxes, citation will be provided. There are two complete first aid kits and first aid manual in the medicine cabinet.

Staff files: LPAs reviewed staff files to ensure staff has fingerprint clearance, association to the facility, and current 1st Aid, CPR certificates.

Client files: LPAs reviewed client records to ensure their files include medical assessments, appraisals, emergency contact information, and admission agreements.

Pursuant to Title 22 Divisions the CA Code of Regulations, there were couple of violations observed the visit, which will be addressed by the licensee. Citations with appeal rights provided. Exit interview conducted and copy of the report issued.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC809 (FAS) - (06/04)
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Created By: Nadia Shahbazian On 11/24/2025 at 04:20 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAS CASITAS ASSISTED LIVING
FACILITY NUMBER: 197605806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2025
Section Cited
CCR
87555(b)(8)

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(b) The following food service requirements shall apply: (8) All food shall be of good quality. Food in expired containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
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Staff immediately removed and destroyed the expired containers. Licensee will ensure there are no expired food items anywhere in the facilty and will keep a record of the purchase dates. POC cleared on today's visit.
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Based on observation, the licensee did not comply with the section cited above in maintianing several containers of expired tomato sauce/salsa in the pantry, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
11/24/2025
Section Cited
CCR87465(h)(5)

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 (h) Medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
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Staff immediately removed the medications from the pill boxes. Licensee will ensure medications are always kept in original containers and only removed during medication administration. POC cleared on today's visit.
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Based on observation, the licensee did not comply with the section cited above, medications were stored in weekly pills boxes, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Troy Agard
NAME OF LICENSING PROGRAM MANAGER:
Nadia Shahbazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/24/2025


LIC809 (FAS) - (06/04)
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