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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610272
Report Date: 10/14/2026
Date Signed: 10/14/2026 02:20:27 PM

Document Has Been Signed on 10/14/2026 02:20 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TOPANGA GARDENS RESIDENTIAL HOME CAREFACILITY NUMBER:
197610272
ADMINISTRATOR/
DIRECTOR:		MACAYLE ILLENBERGERFACILITY TYPE:
740
ADDRESS:21709 RODAX STTELEPHONE:
(818) 325-6870
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 6CENSUS: 5DATE:
10/14/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Macayle IIIenberger- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 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
Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff Jeffery Michael ILLenberger and later with Administrator Macayle IIIenberger.
At approximately 10:15 am, with the assistance of staff, LPA took a tour of the physical plant. The following were observed:
Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen.
Bedrooms: The facility has four (4) bedrooms designated for resident use. Two (2) bedrooms are designated for private occupancy, and two (2) bedrooms are designated for shared occupancy. All four bedrooms currently in use by residents were appropriately furnished with bedding and linens and had sufficient lighting. LPA observed that Room #2, designated for R4, was occupied by a family member of the Administrator. Staff stated that R4 is currently hospitalized and that the Administrator’s family member would occupy the staff room instead. LPA observed the required postings near Bedroom #4. The smoke alarms and carbon monoxide detectors were hardwired and interconnected. LPA tested the devices and found them to be operational. The facility has three (3) fire extinguishers, which were last purchased on October 7, 2026. One is located on the wall near the entrance, the second is in the kitchen, and the third is in the hallway near Bedroom #4.(Continue on 809C)
Mary G Flores
Mariana Agban
DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2026
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 6
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 6
Document Has Been Signed on 10/14/2026 02:20 PM - It Cannot Be Edited


Created By: Mariana Agban On 10/14/2026 at 01:42 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOPANGA GARDENS RESIDENTIAL HOME CARE
FACILITY NUMBER: 197610272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(a)
Personal Accommodations and Services
(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. Administrator family member was using R4's rooms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2026
Plan of Correction
1
2
3
4
Administrator will provide a plan to address the issue by the POC date.
Type B
Section Cited
CCR
87307(d)(2)
Personal Accommodations and Services
(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above. Outdoor entrance is being use for tenants in the ADU located at 21705 Rodax Street which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2026
Plan of Correction
1
2
3
4
Administrator agreed to provide a new facility sketch and a letter to ensure that tenants have a separate entrance gate and must not use the outdoor areas designated for residents by the POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Mariana Agban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/14/2026 02:20 PM - It Cannot Be Edited


Created By: Mariana Agban On 10/14/2026 at 01:42 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOPANGA GARDENS RESIDENTIAL HOME CARE
FACILITY NUMBER: 197610272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87506(a)
Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above. R5 does not have a physical file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2026
Plan of Correction
1
2
3
4
Administrator agreed to provide a copy of R5's file by the POC date.
Type B
Section Cited
CCR
87608(a)(3)
Postural Supports
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. All residents had half rail without a written order from the physician which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2026
Plan of Correction
1
2
3
4
Administrator agreed to provide copy of all the residents physician's order regarding bed rails by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Mariana Agban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TOPANGA GARDENS RESIDENTIAL HOME CARE
FACILITY NUMBER: 197610272
VISIT DATE: 10/14/2026
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

Bathrooms: The facility has two (2) bathrooms. The main bathroom, located in the main hallway, is designated for resident use. The second bathroom is designated for staff use. Both bathrooms were adequately supplied and had functional fixtures. The hot water temperature measured at the main bathroom sink was 109.2 degrees Fahrenheit. No cleaning supplies or hazardous items were observed in either bathroom during the inspection.

Common Areas: The common areas include the living room and dining area, both of which were appropriately furnished. The facility has a nonfunctional fireplace. No fireplace key or fireplace tools were present. The dining room table was large enough to accommodate the facility's licensed capacity. The couches and other seating furniture were in good repair and sufficient for the facility's capacity. LPA observed properly labeled medications secured in a locked cabinet in the hallway. LPA also observed a small, locked room designated for family and pets adjacent to the living area.

Surrounding Grounds: All entrances and exits were free of obstructions. Outdoor furniture appropriate for outdoor use was present. LPA observed an accessory dwelling unit (ADU) located at 21705 Rodax Street, with an entrance accessible from the facility's backyard. LPA was informed that the ADU is currently being rented out. LPA advised the Licensee that the tenants must have a separate entrance gate and must not use the outdoor areas designated for residents. The Licensee agreed to make the necessary changes.

Garage: LPA observed that the Licensee had converted the garage into two rooms for live-in staff. The Licensee stated that a copy of the updated facility sketch, a revised LIC 200, and all other required documentation reflecting these changes would be provided. The laundry area is located in the converted garage and is inaccessible to residents. The LPA inspected the side gate to ensure that no locks had been installed and verified that exits and passageways were clear for emergency evacuation. Resident Files: The LPA reviewed resident records to verify compliance with licensing requirements and the presence of required forms. LPA observed that Resident 5 (R5) did not have a physical file at the facility. (Continue on 809C)

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Mariana Agban
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TOPANGA GARDENS RESIDENTIAL HOME CARE
FACILITY NUMBER: 197610272
VISIT DATE: 10/14/2026
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

Staff Files: LPA reviewed staff records to verify compliance with licensing requirements and ensure that required forms and training documentation were current.

Medications: LPA reviewed medications and medication records to verify proper documentation.

An exit interview was conducted, and appeal rights were provided. Citations were issued pursuant to Title 22, Division 6, of the California Code of Regulations. Refer to LIC 809D for details. A copy of the report was signed and provided.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Mariana Agban
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6