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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610462
Report Date: 03/24/2025
Date Signed: 03/27/2025 09:36:49 AM

Document Has Been Signed on 03/27/2025 09:36 AM - 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:AN ELITE CHATEAUFACILITY NUMBER:
197610462
ADMINISTRATOR/
DIRECTOR:		MCLELLAND, MARY JANEFACILITY TYPE:
740
ADDRESS:500 GEORGIAN ROADTELEPHONE:
(562) 541-2267
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY: 6CENSUS: 6DATE:
03/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Assistant Administrator, William Foy & Caregiver, May PadronesTIME VISIT/
INSPECTION COMPLETED:
06:50 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
At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Caregiver and explained the reason for the visit. Later, Assistant Administrator joined today’s visit.

At 10:15a.m., Caregiver and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. The front main door is the only entrance being utilized at the facility, it has six (06) bedrooms and three (03) bathrooms designated for residents and two (02) staff bathroom. Six (06) private bedrooms and three (03) bedrooms designated for live – in staff, and two (02) bedrooms for Administrator’s son and daughter. Three 03) bedrooms designated for the staff is located on the second floor of the facility, which is only accessible by spiral staircase. Spiral staircase has a locked gate only accessible by the staff. Fire/Earthquake drill was last conducted on 03/01/2025. Required posting observed displayed in the facility hallway (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 72 Fahrenheit. The fire alarm/CO system was tested and observed to be working, it is hard wired and interconnected. No obstructions and or tripping hazards throughout the facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common area was observed to be in good repair. Residents dining table fits six (06) residents.

(Continued to LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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 5
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)
Page: 2 of 5
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: AN ELITE CHATEAU
FACILITY NUMBER: 197610462
VISIT DATE: 03/24/2025
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
26
27
28
29
30
31
32
(Continued from LIC 809)

Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Every bedroom, hallway area and kitchen has smoke/CO detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 107.5°F to 116.9°F and within the required range. Resident’s personal hygiene supplied are kept separate in their private room. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a cabinet in the kitchen. Toxins, cleaning solutions, and soap stored and locked under the sink. Laundry Room: LPA observed detergent, toxins and cleaning supplies washer and dryer machines located next to the kitchen and inaccessible to residents in care. Fire extinguishers were observed to be located throughout the facility. Fire extinguishers were observed to be operable with service date 01/03/2025. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication and first aid kit were observed to be locked in kitchen cabinet inaccessible to residents in care. Garage is detached to the house and observed to be locked and inaccessible to residents. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. The front porch is covered with chairs for lounging at the facility. The outdoor area was enclosed, and there is a pool in the backyard of the facility, which is gated and locked in the premises. Resident Records. Six (06) resident records were reviewed. Three (03) out of six (06) residents record did not have Physician’s Report. Staff Records were also reviewed Administrator’s son and daughter do not have criminal record clearances, associated to this facility. Administrator and Assistant Administrator cardiopulmonary resuscitation (CPR) and first aid training are expired. However, caregiver on duty CPR is current at the time of this visit. Administrator's certificate was observed to be current.

Alteration to exciting facility physical sketch was observed, activity area was converted into son’s bedroom. Alteration was done without notifying Community Care Licensing.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit.

Exit Interview Conducted / A Copy of the Report was provided to Assistant Administrator.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 03/27/2025 09:36 AM - It Cannot Be Edited


Created By: Antonia Alvizar-Ettima On 03/24/2025 at 03:36 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: AN ELITE CHATEAU
FACILITY NUMBER: 197610462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87458(a)
Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in three (03) out of six (06) residents did not have accurate Physician's Report which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2025
Plan of Correction
1
2
3
4
Assistant Administrator will obtain updated complete Physician's Reports for the residents and email them to CCL by POC due date. Assistant Administrator will also keep a copy in resident's record.
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.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Antonia Alvizar-Ettima
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 03/27/2025 09:36 AM - It Cannot Be Edited


Created By: Antonia Alvizar-Ettima On 03/24/2025 at 04:55 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: AN ELITE CHATEAU
FACILITY NUMBER: 197610462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87305(a)
87305(a) Alterations to Existing Building or New Facilities
(a) Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by: Activity room has been converted into Administrator's son bedrooms. There is no permit for the alteration.
Deficient Practice Statement
1
2
3
4
Based on inspection and observation, the licensee did not comply with the section cited above. The licensee made alteration to the existing facility without prior notification to the Licensing Office which poseshhhnnnn a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee will submit new facility sketch including identifying recent changes made to physical plant. In addition written statement will be provided explaining when and how the facility will obtain approved permits for alteration of exisiting bulding as needed.
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.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Antonia Alvizar-Ettima
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2025


LIC809 (FAS) - (06/04)
Page: 5 of 5