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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850526
Report Date: 12/08/2025
Date Signed: 12/08/2025 02:36:03 PM

Document Has Been Signed on 12/08/2025 02:36 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:LOVIES BOARD AND CARE IIFACILITY NUMBER:
565850526
ADMINISTRATOR/
DIRECTOR:		BONOAN, SOPHIAFACILITY TYPE:
740
ADDRESS:1253 CHRISTINA COURTTELEPHONE:
(805) 407-1378
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 6CENSUS: 3DATE:
12/08/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Sophia BonoanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced visit at the facility in conjunction with a complaint investigation that occurred today. LPA met with Administrator, Sophia Bonoan, and explained the purpose of the visit. Entrance interview conducted.

During today’s facility tour and record review conducted with the Administrator, the LPA observed that Resident’s #1(R1’s) file, with an admission date of 11/01/2025, did not contain all required on-boarding documentation. Specifically, the pre-admission appraisal form, a reappraisal form, or an appraisal/needs and service plan. The administrator stated that R1 was referred by the hospital and believed it was not necessary to complete a pre-placement assessment on R1 prior to admission. Regarding the appraisal and the appraisal/needs and service plan, the administrator explained that R1 had a short stay at the facility due to health complications, and the facility did not have sufficient time to complete these documents.

Additionally, it was noted that the facility did not notify Community Care Licensing (CCL) of an apparent fall incident or of a 911 emergency response in which R1 was transported to the hospital. According to the administrator, on 11/01/2025, Resident #1 (R1) slid from their bed; however, the caregiver on duty cushioned the fall with one of their feet. The facility notified R1’s family member, who declined to have emergency services contacted. On 11/04/2025, R1 received an Xray due to ongoing discomfort and pain. On 11/30/2025, R1 was subsequently transported to the hospital via Emergency Services due to an apparent Urinary Tract Infection (UTI). When LPA inquired about the details of the fall, the administrator stated they were not present when the fall occurred.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2025
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LOVIES BOARD AND CARE II
FACILITY NUMBER: 565850526
VISIT DATE: 12/08/2025
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Continued form LIC 809-C

The administrator confirmed that they contacted 911 on 11/30/2025 after observing blood in R1’s urine. Regarding notifying CCL of these events, the administrator stated that they are aware of the CCL reporting requirements, however, because they believe this incident did not occur as a result of facility neglect, they did not believe that it was necessary to report it to CCL. LPA explained to the Administrator that a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence

Furthermore, the LPA requested R1’s plan of care from the hospice agency. According to the administrator, the hospice nurse maintains all notes and the plan of care for R1 in their office. At 10:10 A.M., the hospice nurse was contacted by phone and was asked to email the notes and plan of care to the LPA by noon. The nurse stated that the office was closed at that time and that the documents would be emailed by the end of the business day. As a result, the LPA was unable to obtain these documents during today’s visit. The LPA explained the importance of having required documents readily available and accessible at all times.

Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted, today's reports, civil penalties and appeal rights were reviewed and issued.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 12/08/2025 02:36 PM - It Cannot Be Edited


Created By: Valeria Conway On 12/08/2025 at 12:13 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVIES BOARD AND CARE II
FACILITY NUMBER: 565850526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2025
Section Cited
CCR
87457(c)

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(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed... comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by:
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Administrator agreed to have a complete pre-admission appraisal for all residents. An statement of understanding including this regulation will be provided to CCLD by the POC due date.
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Based on record review, the licensee did not comply with the section cited above. No Preplacement or resident appraisal on file for resident #1 which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/23/2025
Section Cited
CCR87211(a)(1)

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(a) Each licensee shall furnish to the licensing agency such reports…: (1) A written report shall be submitted to the licensing agency… within seven days of the occurrence of any of the events...This requirement was not met as evidenced by:
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From now on the administrator agrees to report any unusual incident to CCL. An in-service staff training will also be conducted on CCL reporting requirements and will be provided to LPA the POC due date.
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Based on interview and record review the Licensee did not comply with the above cited section as CCL did not receive a report/notification of an apparent fall incident or of a 911 emergency response whiich poses a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/08/2025 02:36 PM - It Cannot Be Edited


Created By: Valeria Conway On 12/08/2025 at 12:30 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVIES BOARD AND CARE II
FACILITY NUMBER: 565850526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2025
Section Cited
CCR
87412(f)

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Personnel Records. All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement was not met as evidenced by:
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Administrator agreed to provide requested documentation by the end of the day and complete a written statement of acknowledgement and understanding of 87412.
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Based on observation and interview, the licensee did not comply with the above cited section when R1'’s hospice care plan and notes were not available to CCL, which posed a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2025


LIC809 (FAS) - (06/04)
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