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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200280
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:28:32 AM

Document Has Been Signed on 01/15/2025 11:28 AM - 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DANERRY HOMEFACILITY NUMBER:
079200280
ADMINISTRATOR/
DIRECTOR:		LANGIT, DARLENEFACILITY TYPE:
735
ADDRESS:1028 SANDPOINT DRIVETELEPHONE:
(510) 734-1984
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY: 6CENSUS: 6DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Endaya Esperanza, CAREGIVERTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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LPA Carol Fowler attempted to conduct an unannounced annual random visit. LPA arrived at the home to find no one present. LPA contacted the licensee via telephone, ADM informed LPA that she was not able to meet LPA and the staff will leave the facility when clients are at program and will be back at the facility at 2:00pm.

On 1/15/2025 at 9:40am, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge conducted an unannounced annual 1-year required inspection. LPAs met with Endaya Esperanza Caregiver, and explained the purpose of the visit. The administrator arrived at approximately 10:15am and currently holds a certificate (#6023419735) that expires on 12/16/2024 renewal pending. The facility’s fire clearance was approved for six (6) ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, and back yard. The facility consists of six (6) total bedrooms two (2) rooms are occupied by staff, and two (2) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 107.6 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. Paper towel, and soap observed at all hand washing stations. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods.

Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher was last services on 11/12/2024. Fire drill last conducted 11/14/2024. First aid kit was observed to be complete.

Continued on LIC809C.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: DANERRY HOME
FACILITY NUMBER: 079200280
VISIT DATE: 01/15/2025
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Continued from LIC809.

Four (4) staff records were reviewed, and complete. Four (4) of six (6) clients' records were reviewed and are complete.

The following forms to be updated and submitted to CCLD by 1/24/2025:

· LIC610D Emergency disaster plan (9 pages)
· LIC500 (Personnel Record)
· Client Roster
· LIC308 (Designation of facility Responsibility)

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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