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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610847
Report Date: 01/30/2026
Date Signed: 01/30/2026 04:01:41 PM

Document Has Been Signed on 01/30/2026 04:01 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:MEADOWS, THEFACILITY NUMBER:
197610847
ADMINISTRATOR/
DIRECTOR:		SHERMAN, CELENAFACILITY TYPE:
740
ADDRESS:22901 VOSE STTELEPHONE:
(661) 236-6787
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 0DATE:
01/30/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Celena Sherman and Ukarjit KaurTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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At 9:00 a.m. on 01/30/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing inspection. LPA met with applicants Ukarjit Kaur and Celena Sherman and disclosed the reason for the visit.

Today’s prelicensing inspection is an initial application with no residents in care. The facility is a single story building with three (03) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. The facility has an approved fire clearance for six (06) non-ambulatory residents, of which one (01) may be bedridden in Bedroom #3. The facility intends to serve residents with dementia. Four (04) our of four (04) auditory alarms were on and functional during the visit.

The front yard was maintained and free of hazards. A secure ramp led to the main entrance. Once inside, LPA observed postings for personal rights, theft and loss policy, facility sketch, emergency disaster plan, administrator certificate, theft and loss policy, staff list, sample menu, and confidential complaint contacts.

At 9:10 a.m., LPA and applicants reviewed Component III.

Walls, floors, windows, and screens were clean and in good repair. At 9:50 a.m. LPA measured the room temperature to be 71.4 degrees Fahrenheit. Activities, art supplies, puzzles, and furniture in good repair were available in the living room. A fireplace was adequately covered. A complete first-aid kit and emergency flashlights were present in the living room. A hallway closet contained hygiene supplies and an adequate supply of fresh linens. An office area had a chair, desk, and locked filing cabinet for confidential files.

The facility has two (02) bathrooms. The southern bathroom was designated for residents. It contained liquid soap, paper towels, a trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2026
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MEADOWS, THE
FACILITY NUMBER: 197610847
VISIT DATE: 01/30/2026
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At approximately 10:15 a.m. LPA measured the water temperature in the resident bathroom to be 105.6 degrees Fahrenheit. The facility has three (03) bedrooms. All bedrooms are shared bedrooms and contained a chair, lighting, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

At 10:30 a.m. the smoke and carbon monoxide detectors were tested and deemed operational. Smoke detectors were hard-wired and operated simultaneously when tested. Two (02) out of two (02) fire doors also closed appropriately when tested.

LPA observed an adequate supply of perishable and non-perishable foods in the refrigerator, freezer, and cabinets. The stove hood was clean. Appliances were in good condition. Sharps and cleaning solutions were locked below the sink. Medications were locked in a kitchen cabinet.

The garage was locked and contained an operable washing machine and dryer and additional hygiene supplies and tools. Outdoor areas were maintained and contained fruit-bearing trees. The patio contained furniture in good condition with adequate shade. Ramps leading out were secure. Two (02) out of two (02) emergency exit paths were free from obstructions. Emergency exits were unlocked.

At approximately 11:10 a.m., LPA observed a fire extinguisher near the kitchen. It was last inspected on 10/14/25 and had a tag attached. The fire extinguisher was not fully charged. At 11:30 a.m., the house telephone was called but not operational. Applicants ordered necessary services between 12:30 p.m. and 3:45 p.m. At 3:50 p.m., the fire extinguisher was observed to be fully charged with a tag attached from 01/30/26. At 3:55 p.m., LPA called the house phone and deemed it to be operational.

Pre-Licensing is complete and this facility has no deficiencies.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC809 (FAS) - (06/04)
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