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ICF/DD-H (Habilitative)License activeMedi-Cal certified

TLC - DEVONSHIRE HOUSE

ICF/DD-H (Habilitative) · 6 licensed beds · Chatsworth, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

TLC - DEVONSHIRE HOUSE20619 DEVONSHIRE STChatsworth, CA 91311 · Los Angeles County

Phone: (818) 314-8254

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
6
Administrator
JORDAN, ANDRE
CDPH facility ID
960001678
License number
960000863
First licensed
March 16, 1995
Current license
Mar 16, 2026 to Mar 15, 2027
CDPH district office
La Icf/Dd/Clinics

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
05G896
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
June 26, 1995
Last certification survey
January 14, 2026
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (non-profit)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.5 · LVN/LPN 1 · direct care 7.5 · all employees 9

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BAbuse/Facility Not Self Reported

    Citation - B · Violations: T22 DIV5 CH8.5 ART3-76870 · Violation Oct 22, 2023 · Penalty #960019696 · Survey 6AJH11

    Status: Closed · Not appealed

    $1,550

    initially $1,000

    Citation document ↗

Federal inspections (CMS-2567)

35 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event 31C635-H1 · 1 deficiency

    Official 2567 ↗
  2. · Complaint

    Event K0BP11 · 1 deficiency

    Official 2567 ↗
  3. · Recertification

    Event MU9T11 · 2 deficiencies

    Official 2567 ↗
  4. · Recertification

    Event MU9T21 · 1 deficiency

    Official 2567 ↗
  5. · Complaint

    Event RMG111 · 1 deficiency

    Official 2567 ↗
  6. · Complaint

    Event CMWE11 · no deficiencies cited

    Official 2567 ↗
  7. · Complaint

    Event SLCY11 · no deficiencies cited

    Official 2567 ↗
  8. · Complaint

    Event E0X611 · no deficiencies cited

    Official 2567 ↗
  9. · Complaint

    Event 99K911 · no deficiencies cited

    Official 2567 ↗
  10. · Complaint

    Event 8C1Y11 · no deficiencies cited

    Official 2567 ↗
  11. · Complaint

    Event PEE811 · 1 deficiency

    Official 2567 ↗
  12. · Recertification

    Event F0J121 · 1 deficiency

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

37 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  2. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  3. ReportFederal survey (recertification): 2 deficiencies(state record)

    See this survey →
  4. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  5. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  6. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  7. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  8. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  9. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  10. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.