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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610737
Report Date: 10/01/2025
Date Signed: 10/01/2025 03:58:54 PM

Document Has Been Signed on 10/01/2025 03:58 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LOVING LAS BRISAS LLCFACILITY NUMBER:
197610737
ADMINISTRATOR/
DIRECTOR:		DE LAS ALAS, NICOLEFACILITY TYPE:
740
ADDRESS:5512 LAS BRISAS TERTELEPHONE:
(707) 688-5606
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 6CENSUS: 4DATE:
10/01/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:NICOLE DE LAS ALASTIME VISIT/
INSPECTION COMPLETED:
02:00 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
Licensing Program Analyst (LPA) Melissa Spaeth conducted a visit and was greeted the Licensee, Nicole De Las Alas. The facility is currently licensed for six ambulatory residents; however the facility was approved by the City of Palmdale and the owner of the property for renovation of the resident bedrooms. Exit doors were added to the resident rooms. LPA stated the purpose of the visit was to inspect the facility.

A Fire Safety Inspection Request dated 9/23/2025 was sent to the Woodland Hills CCL office stating the facility has been approved for four (4) non-ambulatory residents and two (2) bedridden clients. Room 1 to house two (2) bedridden residents. Room 2 is designated for staff only. Room 3 to house two (2) non-ambulatory residents. Rooms 4 and 5 to house one (1) non-ambulatory resident. The report also states the Applicant is in the process of reclassifying occupancy to R-3.1 with the local Palmdale Building & Safety authority.

The Licensee stated there are four residents in the facility. LPA stated the residents should not have moved into the facility because the final walk through had not been completed by LPA Spaeth. The Licensee stated they understood.

LPA and the Licensee toured the facility at 10:00 am 10:30 am. LPA observed there were no health and safety issues to report at this time.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2025
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 4
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 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LOVING LAS BRISAS LLC
FACILITY NUMBER: 197610737
VISIT DATE: 10/01/2025
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
LPA reviewed the residents’ records from 11:00 am until 11:35 am and observed residents moved into the facility from August 20, 2025 until September 9, 2025. LPA observed there are three non-ambulatory and one ambulatory resident living in the facility. However, the fire safety inspection took place on 9/23/2205 so the facility had not received fire clearance for non-ambulatory residents.

During LPA’s review of the four residents’ files (R1-R4), LPA observed the Pre-Appraisal/ Appraisal Needs Assessment and Personal Rights documentation were missing from all the residents' records. LPA observed the staff records at 12:45 pm until 1:00 pm.

A $500 immediate civil penalty is assessed today for residents living in the facility prior to the fire safety inspection.



Under Title 22 General Regulations, the following citation was issued and recorded on LIC 809D.

Exit interview was conducted, appeal rights discussed and LPA gave a copy of the report during the visit.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Melissa Spaeth
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/01/2025 03:58 PM - It Cannot Be Edited


Created By: Melissa Spaeth On 10/01/2025 at 12:45 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: LOVING LAS BRISAS LLC
FACILITY NUMBER: 197610737

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/01/2025
Section Cited
CCR
87202(a)(1)

1
2
3
4
5
6
7
87202 Fire Clearance (a)All facilities shall maintain a fire clearance…Prior to accepting or retaining any of... types of persons...obtain an appropriate fire clearance ...(1) non-ambulatory persons.
1
2
3
4
5
6
7
LPA received the fire clearance dated 9/23/2025 stating the facility has been approved for non-ambulatory and bedridden residents. Therefore, the deficiency was cleared during LPA's visit.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Based upon LPA's observations, the licensee failed to receive fire clearance prior to accepting non-ambulatory residents which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
10/06/2025
Section Cited
CCR87505

1
2
3
4
5
6
7
87505 Documentation & Support Each facility shall document ...the pre-admission appraisal and any reappraisal ...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee will fax the Pre-Admission Appraisals and the signed Personal Rights docuemntation for the four residents to LPA Spaeth.
8
9
10
11
12
13
14
Based upon LPA's observations, the licensee failed to complete a pre admission appraisal which could possibly pose an immediate health, safety or personal rights risk to persons 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.
Troy Agard
NAME OF LICENSING PROGRAM MANAGER:
Melissa Spaeth
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4