197606773-10-22-2025-31-AS-MSPH-DMPUAG-20251022152442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606773
Report Date: 10/22/2025
Date Signed: 10/22/2025 03:25:39 PM

Document Has Been Signed on 10/22/2025 03:25 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BEST ELDER CARE III		FACILITY NUMBER:	197606773
ADMINISTRATOR/ DIRECTOR:	FABIOLA IGID		FACILITY TYPE:	740
ADDRESS:	38648 CORTINA WAY		TELEPHONE:	(661) 274-2413
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY: 6		CENSUS: 3	DATE:	10/22/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	FABIOLA IGID		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the caregiver, Gabriela Gagarin. LPA stated the purpose of the visit was to conduct an annual inspection. The caregiver confirmed there are three residents living in the facility. The facility is licensed for two (2) ambulatory and four (4) non-ambulatory residents and a hospice waiver for one resident. The Administrator, Fabiola Igid arrived to the facility.

LPA Spaeth and the caregiver toured the location at 12:15 pm until 12:45 pm.

Common Areas – The living room and dining room are combined. The living room was furnished with comfortable seating. The dining room contained dining room table and chairs. The family room contained a television and comfortable seating.

Medications: LPA observed the resident medications were safely locked in a cabinet in the living room. At 12:20 pm, LPA observed a first aid kit which contained a pair scissors was not securely locked in the medication cabinet. At 12:20 pm, LPA observed the caregiver locked the scissors in the medication cabinet.

Kitchen – LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. The knives and cleaning solutions were locked underneath the kitchen sink. The fire extinguisher was located in the kitchen and was operable.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST ELDER CARE III	FACILITY NUMBER: 197606773
	VISIT DATE: 10/22/2025

NARRATIVE

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Hallway- The linens were located in a hallway cabinet.

Laundry Area – The laundry area contained the washer and dryer. The laundry detergent was locked in a cabinet above the washer.

Garage - LPA observed the garage was locked. The emergency food and water were stored in the garage.

Bathrooms: There are two (2) bathrooms designated for resident’s use. All bathrooms were well lit, clean, had grab bars, nonskid mats and trash bins with lids. At 12:30 pm LPA tested the water temperature and the temperature was 105 degrees F.

Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. The side gate of the house was closed and was not locked. There is a covered patio to provide shade and appropriate outdoor seating for residents.

Smoke/Carbon Monoxide Detectors: The smoke alarms were tested at 12:40 pm and were operable. The carbon monoxide detector was tested at 12:46 pm and was operable.

LPA reviewed resident files at 12:46 pm until 1:15 pm. LPA reviewed staff records at 1:15 pm until 1:40 pm. There were no issues with the facility records.

Based LPA's observations, the following deficiency was cited (see 809-D).

Exit interview conducted, appeal rights discussed, and a copy of this report issued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/22/2025 03:25 PM - It Cannot Be Edited

Created By: Melissa Spaeth On 10/22/2025 at 02:06 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: BEST ELDER CARE III	FACILITY NUMBER: 197606773
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, the licensee failed to safely lock a pair of scissors which were in a first aid kit sitting on the counter, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/22/2025
	Plan of Correction
1 2 3 4	During LPA's visit, LPA observed the caregiver locked the scissors in the medication cabinet.

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.

	Troy Agard
NAME OF LICENSING PROGRAM MANAGER:

	Melissa Spaeth
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

LIC809 (FAS) - (06/04)

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