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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850238
Report Date: 01/27/2025
Date Signed: 01/27/2025 03:40:13 PM

Document Has Been Signed on 01/27/2025 03:40 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:BAGET'S HOMEFACILITY NUMBER:
195850238
ADMINISTRATOR/
DIRECTOR:		BAGET, BADUNG DAVOUFACILITY TYPE:
735
ADDRESS:7524 WISH AVETELEPHONE:
(818) 518-4635
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 3CENSUS: 3DATE:
01/27/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Badug BagetTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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An Informal Conference was conducted today in the Woodland Hills North Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss deficiencies cited in complaint control C#29-AS-20241227130856.

Present at today's meeting included the Licensee (Baget’s Home) Badung Davou Baget, North LA County Regional Center (NLACRC) Ari Stark QA, Licensing Program Manager (LPM) KaSandra Lopez and Licensing Program Analysts (LPA) Sandra Urena and Trevor Byrne.



The informal conference process was explained to the Licensee. The Licensee was informed that this Informal Conference is a part of the administrative action process and that further citations may result in a Non-Compliance Conference, which could lead to a referral for Administrative Review by the Department’s Legal Division for possible Administrative Action.

Brief History: The facility was first licensed on 04/05/2022, for a capacity of three (3) residents.

LPM Lopez discussed deficiencies cited during the complaint investigation, which included failure to provide adequate supervision to clients in care, and failure to provide adequate amounts of available perishable food in the facility for residents in care. At this time, the licensee has cleared the Plan of Corrections in a timely manner. All parties discussed the complaint investigation and potential ramifications of the complaint findings.

The Licensee understood the concerns and confirmed that residents will not be left unsupervised at any time, and sufficient amounts of perishable foods will be available for residents in care. At this time, the licensee has cleared the Plan of Corrections as of 01/08/2025.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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