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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850615
Report Date: 05/07/2026
Date Signed: 05/07/2026 02:58:13 PM

Document Has Been Signed on 05/07/2026 02:58 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PALMS AT BONAVENTURE, THEFACILITY NUMBER:
565850615
ADMINISTRATOR/
DIRECTOR:		MCCAULEY,BRANDYFACILITY TYPE:
740
ADDRESS:111 NORTH WELLS ROADTELEPHONE:
(805) 647-0616
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 121CENSUS: 109DATE:
05/07/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator, Brandy McCauleyTIME VISIT/
INSPECTION COMPLETED:
03:05 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
 On 05/07/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct facility annual inspection, as well as issue final findings to the allegations to a complaint on a separate report. LPA noted that an additional finial finding to allegation of a separate complaint (29-AS-20251024145127) at the same facility location under a different Community Care Licensing (CCL) facility file number (565802467) that is was closed on 06/13/2025 and last updated on 10/28/2025. LPA met with Administrator, Brandy McCauley, announced who he is and the reason for the visit.
The facility is two story and has one elevator. LPA conducted physical plant tour inside and out of the facility. LPA noted fire clearance for 121 non-ambulatory residents and delayed egress is approved for the memory care unit. The facility has ninety (90) private resident bedrooms and fourteen (14) shared rooms. Some shared rooms may be used as private rooms. None of the residents’ rooms have direct exits outside. There is a large dining room and industrial type kitchen located on the first floor and there are medication rooms on both the first floor and second floor where mediations are stored in medication carts and fist aide kits are stored. The common areas were appropriately furnished, and the lighting was adequate. There are activity rooms and television rooms with comfortable seating in assisted living and memory care. There was sufficient space to accommodate both indoor and outdoor activities. Night lights and emergency lighting were maintained in hallways and passageways to non-private bathrooms. There is a screened fireplace located in assisted living adjacent to the large dining room. The exterior passageways were clean and clear of any obstructions. There is a fenced outdoor area with a covered patio for memory care residents. There is a covered patio and outdoor area for assisted living residents. There are no bodies of water on the premises. There is a garage used for storage which remains locked at all times. Maintenance keeps their tools stored in the locked garage. The garage is a stand-alone building and not physically connected to the facility. CONTINUED on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2026
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 3
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 3
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: PALMS AT BONAVENTURE, THE
FACILITY NUMBER: 565850615
VISIT DATE: 05/07/2026
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
 The facility smoke alarm system is hard wired. Facility has carbon monoxide detectors in common areas. The carbon monoxide detectors are tested by maintenance staff monthly. The fire sprinkler system, smoke alarm and fire doors were last inspected 4/16/2025 by fire marshal approved vendors. Maintenance checks smoke alarms and sprinkler systems monthly. Fire extinguishers are inspected by maintenance and annually by an approved vendor with the last annual inspection having been completed on 4/10/2025. Administrator stated that the next vender fire inspection is scheduled for May of 2026 pending bid approval.

Administrator and LPA conducted a full physical tour of the facility and grounds and there were no violations noted. Administrator and LPA conducted a full review of the care tools modules and noted no violations or citations noted. LPA conducted file review of Resident and Staff files, Emergency Disaster Plan, Infection Control Plan, Centrally Stored Medication Records, Medication Administration Records, and Facility Liability Insurance coverage. LPA noted not violation and no citations during this full annual inspection.

Exit interview, report read and report provided.
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3