<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610161
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:54:17 PM

Document Has Been Signed on 02/04/2025 02:54 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:BETD SAN FERNANDO CARE LLCFACILITY NUMBER:
197610161
ADMINISTRATOR/
DIRECTOR:		TIKU, ELIZABETH A.FACILITY TYPE:
740
ADDRESS:628 NORTH LAZARD STREETTELEPHONE:
(818) 493-8351
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 6CENSUS: 4DATE:
02/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Elizabeth TikuTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/04/2025 Licensing Program Analysts (LPAs) Lorena Casillas and Nadia Shahbazian arrived at facility above to conduct an initial 10-day complaint investigation for complaint 31-AS-20250131082825. This Case Management is related not to the original complaint visit. During facility records review it was discovered that Administrator does not have a valid Administrator Certificate. Administrator certificate shows to have been expired on 12/10/2024, Administrator admitted to not having completed all necessary continuing education hours required for recertification. Based on interview with Administrator and Administrators own admission there is no qualified and currently certified Administrator at the facility. Furthermore, it was also discovered that facility does not have valid liability insurance coverage. LPAs advised Administrator that there will be citations issued.

Citations issued. Appeals rights discussed and provided. Exit interview conducted and a copy of the report given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/04/2025 02:54 PM - It Cannot Be Edited


Created By: Lorena Casillas On 02/04/2025 at 01:29 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: BETD SAN FERNANDO CARE LLC
FACILITY NUMBER: 197610161

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2025
Section Cited
CCR
87405(a)

1
2
3
4
5
6
7
87405(a) Administrator Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. Tthis was not met as evidence by:
1
2
3
4
5
6
7
Administrator discussed and agreed to submit all required documentation for certificate renewal by POC due date and will email LPA Casillas verification.
8
9
10
11
12
13
14
Based on interview and record review the Administrator failed to renew Administrator certificate, this poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
Type B
02/11/2025
Section Cited
HSC1569.605

1
2
3
4
5
6
7
1569.605 Liability Insurance. On and after July 1, 2015, all residential care facilities for the elderly…shall maintain liability insurance ...of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000)…This was not met as evidence by:
1
2
3
4
5
6
7
Administrator will purchase liability insurance and will submit proof via email to LPA Casillas by POC due date.
8
9
10
11
12
13
14
Based on record review, facility does not currently have valid or active liability insurance, this poses a potential health and safety risk to residents in care
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Lorena Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2