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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610462
Report Date: 10/29/2025
Date Signed: 10/29/2025 03:02:09 PM

Document Has Been Signed on 10/29/2025 03:02 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: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:
10/29/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Sean V. Abalajon - Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA’s) Mariana Agban and Evelin Rios conducted a Case Management - Deficiency visit in conjunction to Complaint Control Number 31-AS-20251024154115. LPAs were granted access by caregiver and met with Assistant Administrator, Sean V. Abalajon shortly after. LPAs explained the reason for the visit.

During the physical plant inspection, LPA Rios observed medications stored in two (2) of the six (6) resident bedrooms. A review of all six (6) residents’ records revealed that Resident #2’s (R2’s) Physician’s Report (LIC 602) indicates R2 as unable to manage or store their own medications. Resident #3 (R3) had an incomplete LIC 602 that did not specify whether they are capable of storing their own medications. In an interview, the Assistant Administrator stated that R2 “chooses” to keep their medications, and there for the facility allows it. They also informed LPA Rios that R3 has a diagnosis that could pose a health and safety risk if R3 were given access to their medications.

During the physical plant tour, LPA Rios observed a medication organizer in R2’s bedroom, as well as another organizer in the facility’s medication cabinet. Several small containers filled with various pills were also observed. According to the Assistant Administrator, medications for Residents #1 (R1) and R2 are arranged in weekly organizers due to the volume of medications they require. For the four (4) other residents, medications are placed into small containers labeled “AM” and “PM” to provide scheduled medication.
A review of the facility’s medication management policy revealed that all medications are required to be locked, centrally stored, and kept inaccessible to residents. Additionally, the policy states that medications must be prepared by staff in a medication cup one hour prior to administration, in accordance with physician orders.
(Continue to LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025
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: AN ELITE CHATEAU
FACILITY NUMBER: 197610462
VISIT DATE: 10/29/2025
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(Continued from LIC809)

During the backyard physical plant inspection, LPAs observed that two gates providing access to a filled pool were unlocked and left open. In an interview, the Assistant Administrator revealed that the facility had hosted a gathering about three weeks ago and had forgotten to close the gates since then.

An interview with the Assistant Administrator revealed that R3 began receiving hospice services following an incident that required emergency medical attention. However, a review of the Woodland Hills Regional Office files by LPA Rios showed that no incident report had been submitted regarding this event. The Assistant Administrator was uncertain about the date of the incident, and R3’s hospice folder lacked documentation indicating the start of care. Additionally, the LPA was unable to locate a Hospice Notification.

Deficiencies cited (Refer to LIC809-D).

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

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

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/29/2025 03:02 PM - It Cannot Be Edited


Created By: Evelin Rios On 10/29/2025 at 01:25 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: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/30/2025
Section Cited
CCR
87307(e)(2)(A)

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(e) The licensee shall supervise residents as needed... when there is use of the following items: (2)...swimming pools...(A) The licensee shall ensure... are inaccessible... when not in active use by residents. This requirement is not met as evidenced by:
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Assistant administrator closed the gates during visit and agreed to submit a picture with the gate locked with a chain to LPA by POC due date 10/30/2025.
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Based on observation and record review, the licensee did not comply with the section cited above in allowing access to a pool from two gates when not in active use by residents which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
11/14/2025
Section Cited
CCR87465(h)(5)

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(h) The following requirements shall apply to 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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Medication organizers shall be removed and residents medication shall be stored in their originally received containers.
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Based on observation and record review, the licensee did not comply with the section cited above six (6) out of (6) resdients having medication transfered between containers which poses an potential health, safety or personal rights risk to persons in care.
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Assistant Administrator agreed that all staff responsible for providing residents with medication assistance of self administration will complete medication training and submit sign in sheet with training material covered to LPA by POC due date 11/14/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/29/2025 03:02 PM - It Cannot Be Edited


Created By: Evelin Rios On 10/29/2025 at 01:53 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: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2025
Section Cited
CCR
87465(h)(5)

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h)The following requirements shall apply to medications...(1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers... due to physical arrangements in the facility and the condition or the habits of other persons in the facility...
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The facility will centrally store all medications as indicated in their Program. Assistant Administrator will notify LPA that the medication will be centrally stored.
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This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in two (2) out of (6) residents storing medication in their bedrooms which poses an potential health, safety or personal rights risk to persons in care.
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Type B
10/29/2025
Section Cited
CCR87211(a)(1)

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(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to...the following: (1)A written report shall be submitted to the licensing agency...This requirement is not met as evidenced by:
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The assistant administrator agreed to submit incident report and statement of understanding for the regulation cited to LPA by POC due date.
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This requirement is not met as evidenced by: Based record review and interview, the licensee did not comply with the section cited above in one (1) out of (6) residents had a medical emergency and then started Hospice Services without notification or report submitted to Licensing which poses an 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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/29/2025 03:02 PM - It Cannot Be Edited


Created By: Evelin Rios On 10/29/2025 at 02:17 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: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2025
Section Cited
CCR
87463(h)(1)

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(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment.(1)Documentation of the annual routine visit... added to the resident's record.
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Assistant Administrator agreed to schedule R3 for a medical assesment and obtain an updated LIC602 and submit a copy to LPA by POC due date 11/14/2025.
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Based on interviews and record review, the licensee did not comply with the section cited above 1 out of 6 residents having an LIC602 form 2023 even with a change in condition and diagnoses which poses an 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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2025


LIC809 (FAS) - (06/04)
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