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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607356
Report Date: 02/11/2026
Date Signed: 02/11/2026 12:04:00 PM

Document Has Been Signed on 02/11/2026 12:04 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:DE LA VEGA ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197607356
ADMINISTRATOR/
DIRECTOR:		EILEEN TAGDULANGFACILITY TYPE:
735
ADDRESS:17521 TUBA STREETTELEPHONE:
(818) 366-3282
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 5DATE:
02/11/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Michael Tagdulang, Direct Support StaffTIME VISIT/
INSPECTION COMPLETED:
12:15 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
On 02/11/26 at 9:40 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with DSP-Direct Support Staff--Michael Tagdulang. LPA asked for the census, staff and client files.

The physical plant was toured inside and out at 10:35 am. This is a level 2 facility with ambulatory residents.

Living Room Area: LPAs observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 71 degrees Fahrenheit with a large television.

Bedrooms: There are seven (7) bedrooms. Five (5) bedrooms are used for clients and two (2) bedrooms are used for staff. The bedrooms have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the client’s room. The client rooms are single, occupied. There is a hallway that divides the rooms and the hallway there is office set-up. The staff rooms were also toured.

Bathrooms: There are three (3) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. Two (2) bathrooms are used for clients and one (1) bathroom is used for staff. The hot water temperatures were measured within regulations of 117.1 degrees. The showers have non-slip bathmats and grab bars.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is no garage. The washer and dryer are located on your right hand side of the kitchen.

809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2026
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 3
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 3
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: DE LA VEGA ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197607356
VISIT DATE: 02/11/2026
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
Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation with several pantries for canned food. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets. There is another refrigerator located that can be accessed from the kitchen area.

The knives/sharps are kept in the locked area in the staff bathroom.

Medications: The medication is kept on your right hand side of the kitchen locked and inaccessible to the clients. The first/aid kit is kept in the staff's bathroom. There is two (2) first/aid kits.

There is no a signal system in the facility. There is one (1) fire extinguisher fully charged and expires on May-2025. It is located in the kitchen.

Outside: LPA toured the outside area. LPA observed a covered shaded area for clients and appropriate outdoor furniture. The facility has a pool that is fenced and gated inaccessible to the clients. There is also a shed that has storage in it on your right hand side.

Administration: The Liability Insurance was reviewed and obtained. There are several Covid 19 signs on the wall, hygiene sanitation signs, and the Rights of Individuals with Developmental Disabilities, YES, Emergency Disaster Plan and Facility Grievance Procedure, house rules located against the wall of the dining hall. The last fire drill was conducted 11/2025.

Staff/Client Files: Three (3) staff files were reviewed and five (5) client files were reviewed.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the DSP-Direct Support Staff.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3