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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607357
Report Date: 03/05/2025
Date Signed: 03/05/2025 12:04:26 PM

Document Has Been Signed on 03/05/2025 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:DAVENPORT HOME, THEFACILITY NUMBER:
197607357
ADMINISTRATOR/
DIRECTOR:		GAMZE DAVENPORTFACILITY TYPE:
735
ADDRESS:5722 PADDINGTON DRIVETELEPHONE:
(661) 533-9790
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 2DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Gamze Davenport-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 3/05/2025 at approximately 09:40 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Administrator Gamze Davenport and LPA stated the reason for their visit.

LPA asked for the census, Staff/Client Roster, and liability Insurance. LPA conducted a physical plant tour at approximately 10:30 AM and the following was noted:

The facility is a two-story building with six (6) bedrooms and four (4) bathrooms currently occupying two (2) clients. One (1) client room and one (1) bathroom are located downstairs. The remainder of the bedrooms and bathrooms are located upstairs. There is a designated staff room with its own private bathroom. The facility has an approved fire clearance for six (6) ambulatory clients. The facility is vendor through North Los Angeles Regional Center (NLARC) and is being operated at a Level II Adult Residential Home. Sign in sheet, hand sanitizer, gloves and masks are available.

Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 71°F. Multiple fire extinguishers were observed to be located near the facility entrance and dated 01/22/25. LPA observed required postings such as See/Say Something, Facility License, and Personal Rights. A fireplace was observed to be covered and inaccessible to clients. A working telephone was observed.

Kitchen: Kitchen observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. LPA observed additional refrigerators and freezers used to store extra food. Knives, sharps, cleaning solutions and disinfectants observed to be kept in a locked storage closet near the laundry room. Kitchen appliances observed to be working and in proper condition. (continued on LIC 809-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DAVENPORT HOME, THE
FACILITY NUMBER: 197607357
VISIT DATE: 03/05/2025
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Bedrooms: The clients’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in a storage cabinet located upstairs.

Bathrooms: Bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 111.2 °F.

Garage: The garage can be accessed from inside of the facility and was observed to be located near the laundry room. The garage was observed to be used for storage purposes. Cleaning supplies and toxins observed locked in storage closet alongside the laundry room and inaccessible to clients. Laundry Room: The laundry room is located inside the facility near the garage. Laundry appliances observed to be working and in proper condition.

Staff Room: LPA observed staff room locked and inaccessible to clients.

Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for clients. There is no body of water located at the facility.

Medications: Medications were observed stored in a locked file cabinet located upstairs. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and First Aid manual.

Smoke detectors and carbon monoxide observed to be working properly and were tested. The Last Fire Drill was conducted on 2/21/25.

Clients/Staff Records: LPA conducted a complete file review of client records. Client records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated.

There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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