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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850047
Report Date: 07/09/2026
Date Signed: 07/09/2026 06:05:35 PM

Document Has Been Signed on 07/09/2026 06:05 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:VALLEY VISTA RESIDENTIAL CARE IIIFACILITY NUMBER:
405850047
ADMINISTRATOR/
DIRECTOR:		EVELYN STRAMPEFACILITY TYPE:
740
ADDRESS:1557 GALLEON WAYTELEPHONE:
(805) 439-4120
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 6CENSUS: 5DATE:
07/09/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:05 PM
MET WITH:Licensee/Administrator - Evelyn StrampeTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
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At 3:45pm, on 7/9/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a case management - other visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit.

Today, 7/9/2026, at 10:24am this LPA received a call from Witness #1 (W1) stating they visited the facility and noted medications in the refrigerator were not locked up. The Licensee went to put the medications in a refrigerator in the garage where W1 observed Person #1 (P1), in the garage of the facility and it appeared as though P1 was living in the garage. When W1 asked the Licensee who P1 was the Licensee stated P1 is a family member.

At 10:46am LPA called the Licensee and the Licensee stated that they had left unlocked insulin pens in the refrigerator located inside the facility because there was not enough room in their locking box where they keep other medications in the refrigerator. When asked about P1 the Licensee stated that P1 is a family member and is not cleared. The Licensee also stated P1 has been living in the garage since 6/30/2026.

When LPA arrived at the facility for today's visit LPA noted two people in the garage. P1 identified who they were and Person #2 (P2) stated they are also a family member of the Licensee. P1 and P2 stated they have both been living and sleeping in the garage and they are working to leave by this evening. Licensee states P1 and P2 have come inside the facility to use the bathroom. Record review revealed P1 and P2 have not been cleared to work or reside at the facility and the Licensee states they have not sent them for fingerprint clearance.
(Continued on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2026
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: VALLEY VISTA RESIDENTIAL CARE III
FACILITY NUMBER: 405850047
VISIT DATE: 07/09/2026
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LPA toured the facility with the Licensee and during the tour noted an unopen bottle with thirty (30) tablets of aripirazole 5mg belonging to a former resident and a bottle with one hundred twenty two (122) tablets of quetiapine fumarate 50mg belonging to a current resident, both in an un-lockable drawer of a dresser located behind the living room couch accessible to residents in care. Licensee stated they do not know how they got there. Licensee took the medications and locked them up with the other medications.

Exit interview conducted, deficiencies cited on LIC809-D pages, two civil penalties for $100 per day for a maximum of 5 days in the amount of $500 each for criminal record clearance violation is being assessed on the attached LIC421BC, a civil penalty for a repeat violation within the last twelve months in the amount of $250 is being assessed on the attached LIC421FC, appeal rights and report provided to the Licensee.
NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2026 06:05 PM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 07/09/2026 at 04:24 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: VALLEY VISTA RESIDENTIAL CARE III
FACILITY NUMBER: 405850047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2026
Section Cited
CCR
87355(e)(2)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee states P1 and P2 will spend the night at a hotel tonight and furture nights until they have another place to stay. They also stated they will work to have P1 and P2 cleared.
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This requirement was not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above when P1 and P2 were residing at the facility and not cleared, which poses an immediate health and safety risk to residents in care.
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Type A
07/10/2026
Section Cited
CCR87465(h)(2)

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(h) ...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by:
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Licensee stated they ordered a larger lock box for refrigerated medications and will email the invoice to the LPA. They also stated they will create a log to track thorough checks of the facility have been conducted weekly for unlocked meds and hazardous items. They also state they will work to
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Based on observation and interviews, the licensee did not comply with the section cited above when they left medications unlocked in the kitchen refrigerator and dresser behind the couch in the living room accessible to resident which poses an immedicate health and safety risk to residents in care.
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minumuize how much stuff they have in the facility so they can better track what they have. Licensee will submit the weekly check sheet to the LPA by 7/10/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Garrett Haner-Tomasko
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2026 06:05 PM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 07/09/2026 at 04:49 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: VALLEY VISTA RESIDENTIAL CARE III
FACILITY NUMBER: 405850047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2026
Section Cited
CCR
87307(a)

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(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. This requirement was not met as evidenced by:
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Licensee states no one will reside in the uncleared garage and they will submit a statement of understanding of this regulation to the LPA by 7/23/2026.
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Based on observation and interviews, the licensee did not comply with the section cited above when they allowed P1 and P2 to reside and sleep in the uncleared garage which poses 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.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Garrett Haner-Tomasko
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
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