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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607726
Report Date: 01/28/2026
Date Signed: 01/28/2026 05:08:40 PM

Document Has Been Signed on 01/28/2026 05:08 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:WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTERFACILITY NUMBER:
197607726
ADMINISTRATOR/
DIRECTOR:		EDINA LEMUSFACILITY TYPE:
740
ADDRESS:45221 30TH STREET WESTTELEPHONE:
(661) 974-7035
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 60CENSUS: 41DATE:
01/28/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Administrator Edina LemusTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On 1/28/2026 at approximately 9:50 a.m., Licensing Program Analysts (LPAs) Evelin Rios and Lorena Casillas conducted an Annual Required visit. Upon entry LPAs signed in by a security guard at reception. LPAs met with Assistant Administrator Wendi Doyon and explained the reason for the visit. LPAs later met with the Administrator, Edina Lemus. The Inspection Tools was used to complete this visit.

LPAs requested a copy of the following: resident roster, personnel report, last fire inspection, menu and activities calendar.

At approximately 10:46 a.m., LPA Rios initiated a physical plant tour and the following was observed: By the main entrance and throughout the facility LPA observed appropriate postings such as, resident's rights, Rights of Resident Council, the facility's activity calendar, menu and emergency evacuation routes.

Kitchen: The kitchen has an industrial setting and observed to be clean and in proper order. Appliances and fixtures were observed to be functional. Sufficient amount of perishable and non-perishable food was in stock and properly stored. Kitchen is inaccessible to residents. Dishwashing liquids and other cleaning agents are separate from food preparation areas. LPA discussed food delivery, meal planning and overall food monitoring with the Food Manager, A. Sebert. According to the Food Manager the facility hosts a monthly meeting open for residents to discuss future menus. LPA also observed the 72 hour supply of food in the facility and was informed by the Food Manager that another eight (08) day supply of emergency non perishable supply of food is kept in storage by the facility.
(Continue to LIC809)
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2026
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: WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER
FACILITY NUMBER: 197607726
VISIT DATE: 01/28/2026
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(Continued from LIC809) Common Areas: These include the activity room, lounge, snack rooms, laundry rooms and dining areas. The furniture is in good repair. Hallways and passageways are free of obstruction.

Surrounding Grounds: Entry/exits and hallways were free of obstruction. There is a courtyard accessible to residents with appropriate outdoor furniture. The outdoor area was free of hazards. There are no bodies of water.

Bedrooms: LPA toured five (05) resident bedrooms of which two (02) were private use and three (03) were shared. LPA observed rooms were clean appropriately furnished and had sufficient storage and lighting.

Bathrooms: LPA toured five (05) resident bathrooms and found that all bathrooms were clean and equipped with the required grab bars, non-slip flooring, and an adequate supply of toilet paper and hand soap.

Medications: At 11:42 a.m., LPA Rios, with the assistance of Licensed Vocational Nurse (LVN) J. Ulmer, conducted a review of medications and medication records at one (1) of the two (2) nursing stations. All centrally stored medications were observed to be securely locked in medication cabinets and properly labeled. Medications requiring refrigeration were stored appropriately in the designated medication refrigerator. With assistance from the LVN, LPA reviewed both the physical medications and the electronic medication records.

LPA Casillas reviewed facility's Emergency Disaster Plan (LIC610E), Emergency Operation Plan, Fire and Safety Inspection (STD850) for the modular unit, Fire Drills, Liability Certification and Bond and specialty insurance.

LPA Casillas reviewed the annual inspection report conducted by the County of Los Angeles Fire Department. The CA Department of Forestry and Fire Protection conducted an annual inspection on 02/19/2025. Report states that there were no deficiencies noted and that required corrective action previously mentioned have been corrected. LPAs also examined the facility’s infection control plan, fire drill records last conducted on 12/23/25, and after-action reports for both the "Shake Out" drill and the reception of West Los Angeles RCFE residents affected by the Palisades Fire. Facility provided LPAs with a fire system smoke detector inspection conducted by Champions Fire System Inc certifying no defects for devises. It appears all fire extinguishers were last serviced on 01/12/2026.

(Continued to LIC809-C) Page 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER
FACILITY NUMBER: 197607726
VISIT DATE: 01/28/2026
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(Continued form LIC8090C)

From approximately 1:30 p.m. to 4:32 p.m., LPAs, with the assistance of Supervising Psychiatric Social Worker, S. Misra and Registered Nurse (RN) M. Altamirano, reviewed ten (10) resident records to verify completeness and compliance with licensing standards. Additionally, with the support of C. Ezparza, LPAs reviewed six (6) staff records to ensure adherence to licensing requirements and confirmation of current training.



Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during today’s visit. Exit interview conducted. Copy of this report issued.

(Page 3 of 3)

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4