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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850431
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:13:46 PM

Document Has Been Signed on 05/09/2025 12:13 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CINNAMON GARDEN HOMEFACILITY NUMBER:
565850431
ADMINISTRATOR/
DIRECTOR:		FRAME, TAMMYFACILITY TYPE:
740
ADDRESS:1534 WAKEFIELD AVETELEPHONE:
(805) 870-4193
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 6DATE:
05/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Tammy Frame - Administrator TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Administrator Tammy Frame and explained the reason for the visit. The LPA along with Administrator 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.

INTERVIEWS: From 9:49 a.m. – 10:07 a.m. One (1) staff and two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit.

COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 11:07 a.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The three (3) fire extinguishers were observed and fully charged on 5/8/2025. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 03/25/2025 and conducted quarterly. Activities were observed in the common areas. The facility has a working telephone on the premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction.

GARAGE: The garage was observed locked and inaccessible to residents at the time of the visit. The facility has a sufficient supply of emergency food and water which was observed to be in good condition. LPA observed a freezer in the garage, the food was inspected for dates and food labels that had expiration dates clearly marked. Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CINNAMON GARDEN HOME
FACILITY NUMBER: 565850431
VISIT DATE: 05/09/2025
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Report Continued from LIC 809...

KITCHEN: The LPA inspected the kitchen/food service area at 10:11 a.m. The hot water temperature was measured at 10:12 a.m. and measured at 107.8 degrees Fahrenheit within the required range. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration. Dates and food labels had expiration date clearly marked. The knives and sharps were observed in a locked drawer inaccessible.

BEDROOMS: The facility is a single-story residential home with six (6) private, single occupancy resident bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: There are three (3) restrooms of which two (2) are private resident use and one (1) is a shared, common use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. The restrooms were sufficiently stocked with hand liquid soap and paper towels; towels and washcloths are not shared. The hot water temperature was measured in all restrooms from 10:22 a.m. – 10:27 a.m.; and measured between 109.5 – 113.9 degrees Fahrenheit all within the required range.

LAUNDRY ROOM: LPA observed the locked laundry room with a washer and dryer. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. The LPA observed a sufficient supply of Personal Protection Equipment (PPE).

BACKYARD: The backyard has an area equipped with outdoor furniture including a table and chairs for resident use with appropriate shade. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. Emergency exits and passageways were observed free of obstructions and hazards.

Documents obtained: LIC 500 Personnel Report, LIC 9020 Resident Roster, and Liability Insurance.

Due to time constraints an LPA will return to complete the annual at a later date.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Erica Mosley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC809 (FAS) - (06/04)
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