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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610472
Report Date: 03/17/2026
Date Signed: 03/17/2026 12:15:44 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/17/2026 12:15 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:AV RCFE, OLDFIELDFACILITY NUMBER:
197610472
ADMINISTRATOR/
DIRECTOR:		DE GUZMAN,FERNANDO JR.FACILITY TYPE:
740
ADDRESS:839 EAST OLDFIELD STREETTELEPHONE:
(661) 418-0425
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 6CENSUS: 0DATE:
03/17/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Fernando DeGuzmanTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 03/17/2026 Licensing Program Analyst (LPA) Lorena Casillas conducted an announced annual visit to this facility. LPA arrived at 9:30 am, however, there was no one at the facility. LPA called and spoke to Administrator Fernando DeGuzman who stated that they were on their way to the facility. Administrator arrived shortly after. LPA spoke to Administrator and explained the reason for the visit. Entrance interview conducted.

Infection Control and Emergency Preparedness Plan: LPA reviewed facility Infection Control Plan and Emergency Preparedness Plan to make sure protocols are being reviewed and/or updated. Plans were discussed and updated.

At 11:30 am LPA began the facility tour with the Administrator and the following was observed. The facility has no residents currently living in the home therefore the tool kit was not used during this visit. The facility has a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident. The facility has six (6) approved hospice waivers.

Common Areas: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 71°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational.

Bedrooms: There are three (3) bedrooms for resident use, which contain beds, a mattress on each bed, linens, nightstand, lamp, chair, chest of drawers, and a closet. All window screens were in good repair.

Continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2026
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 3
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: AV RCFE, OLDFIELD
FACILITY NUMBER: 197610472
VISIT DATE: 03/17/2026
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Kitchen: The facility has a seven-day supply of non-perishable foods and will have a two-day supply of perishable foods when residents are acquired. There are two (2) fire extinguishers, one is located in the kitchen and the other in a hallway, both were full and last purchased on 02/20/26. Appliances in the kitchen appeared to be functional. The medication will be locked in a medication cabinet which is stored on the kitchen counter. The knives are located in a locked kitchen drawer. The kitchen appeared to be clean and clear of clutter and free of pests.

Bathrooms: There are two (2) bathrooms that are equipped with hand soap, paper towels, grab bars, slip resistant mats and trash cans with lids. The water temperature was tested at 12:00 pm and was within regulation at 112°F.

Laundry/Garage: The washer and dryer were in the garage and appeared to be in good repair. There is a hallway closet that was locked and contained cleaning solutions. A hallway cabinet contained linens and personal hygiene items. LPA observed additional stored items in the garage.

Surrounding Grounds: The backyard contained comfortable seating. The side gate leading from the backyard to the front yard was not locked. Passageways were clear of obstructions. LPA observed door alarms throughout the facility, and they were observed to be functional.

Resident & Staff files: No current residents or staff, files were not reviewed.

Resident & Staff interviews: No interviews conducted as there are no residents or staff.

Administrative: All fees are current.

No citations issued. Exit interview conducted. Copy of report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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