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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801947
Report Date: 10/08/2025
Date Signed: 10/30/2025 04:20:40 PM

Document Has Been Signed on 10/30/2025 04:20 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ENDURING OAKS ASSISTED LIVING, LLCFACILITY NUMBER:
565801947
ADMINISTRATOR/
DIRECTOR:		MIRVAT YACOUBFACILITY TYPE:
740
ADDRESS:4264 COLIBRI COURTTELEPHONE:
(805) 530-3818
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 6CENSUS: 4DATE:
10/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Mirvat Yacoub & Assistant Administrator Janette VillapandoTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted a required annual visit to this facility today. Upon arrival LPA met with caregiver, who called Administrator Mirvat Yacoub. LPA spoke with Administrator and informed her of the reason for todays visit. Ms. Yacob, arrived to the facility however was not able to stay for the annual visit. Assistant Administrator Janette Villapando was authorized to sign today’s report.

At approximately, 11:30am, LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Required postings observed in the common area. The facility maintained a comfortable temperature of 75 degrees.

Common spaces: The common areas were observed to be properly furnished at the time of the visit. Furniture was observed to be in good condition. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. There is a fireplace in the Living Room, which was observed to be adequately screened. Bedrooms: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four (4) total bedrooms, two (2) shared and two (2) private, and one (1) staff room. Room #2 is cleared as a bedridden room. LPA observed that Room #2 is equipped with a fire door, and it has a direct exit to the backyard in case of an emergency. No bedroom was used as a passageway to another room, bath, or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Bathrooms: Two (2) bathrooms. One (1) shared and one (1) in the master room, Room #1. Resident bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. All bathrooms were supplied with appropriate paper and hygiene products. Hot water temperature was measured in all resident bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit (109 -110.5*F) at the time of the visit. (Continue)
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2025
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ENDURING OAKS ASSISTED LIVING, LLC
FACILITY NUMBER: 565801947
VISIT DATE: 10/08/2025
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Kitchen: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food at the time of the visit. Food labels were inspected and checked for dates and expiration dates. Refrigerated and frozen foods were stored at proper temperature. Knives and sharps observed locked in a drawer next to the kitchen stove. Cleaning supplies were stored under the kitchen sink locked and inaccessible at the time of the visit. There were no pesticides or poisons observed near any food areas. Garage/Office: The garage is kept locked and inaccessible at all times. The garage is where the washer and dryer are held. Cleaning supplies and disinfectants are kept in locked cabinets in the garage all cleaning compounds were stored in areas separately from food supplies. The LPA observed another freezer in the garage with additional food. An adequate supply of emergency food and water was observed. In the garage there is an office area. Next to the office desk, there is a locked file cabinet where both staff and resident files are securely stored. Outdoor Space: The backyard area contains a shaded area with a table and chairs for resident use. There is one (1) side gate with self-latching mechanism and a working alarm. Passageways were observed to be clear and free of hazards. There were no bodies of water noted at the time of the visit.

File review: At approximately 12P.M., LPA began review of resident records. LPA reviewed four (4) residents files for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time. At approximately 12:45P.M. five (5) personnel records including Administrator and Assistant Administrators’ files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, and a copy of limited liability insurance. Last emergency disaster drill was conducted on 07/15/2025.

Fire extinguisher is fully charged, and recently serviced on 04/15/2025. Combination smoke and carbon monoxide detectors were tested at 2P.M. and were operational at this time.

Medication review: Medications are centrally stored in a cabinet by the kitchen locked and inaccessible to residents in care. Medication review began at 2:15P.M.; LPA reviewed medication log for all four (4) residents. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record.



No deficiencies cited at this time. Exit interview conducted and copy of the report provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC809 (FAS) - (06/04)
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