197607709-7-16-2026-31-AS-NSHN-DW329K-20260716171205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607709
Report Date: 07/16/2026
Date Signed: 07/16/2026 05:12:12 PM

Document Has Been Signed on 07/16/2026 05:12 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:	EASTER SEALS SOUTHERN CALIFORNIA VALLEY HOME		FACILITY NUMBER:	197607709
ADMINISTRATOR/ DIRECTOR:	VEGA TAPIA, DANNY		FACILITY TYPE:	735
ADDRESS:	1217 N VALLEY ST		TELEPHONE:	(818) 846-0032
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY: 3		CENSUS: 3	DATE:	07/16/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Sabrina Godinez-Director		TIME VISIT/ INSPECTION COMPLETED:	04:30 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	Licensing Program Manager (LPM) Mary Flores and Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual visit at the facility using the CARE inspection tool. LPM/LPA met with Edgar Arana – Training Administrator and explained the reason for the visit. Sabrina Godinez - Director arrived shortly after. Facility is licensed to serve 3 clients age range 18 through 59, of which 3 may be non-ambulatory. The single home is located in a residential facility and consists of 3 client bedrooms, 2 bathrooms, a kitchen, a living room, a dining room, an office, a laundry area, a back yard, a front yard, and a detached garage. The following CARE tool domains were reviewed during this visit: Infection Control: Facility maintains an infection control plan which was last reviewed on 7/16/26. Hand sanitizing and infection prevention were observed at the facility. A responsible person was available at the facility. Physical Plant & Environmental Safety: LPM/LPA toured the facility with Sabrina Godonez and observed the facility is in good repair indoors and outdoors. The office has a fireplace which is covered and inaccessible to the clients. Each client’s bedroom has sufficient lighting, the required furniture and bedding supplies. Two (2) bathrooms were observed. Bathrooms were observed clean and in good repair. Water temperature was tested in both bathrooms tested between 114.3 -117.5 degrees F., which is within the required 105-120 degrees F. Carbon Monoxide/Smoke detectors were tested and are in working condition. Laundry area is located outside the kitchen; dryer was observed to have a loud tumbling noise but is working a work order to replace the dryer was placed on 7/11/2. The backyard offers shaded seating area for the clients. Garage is not accessible to the clients. Passageways and exit areas were observed free of obstructions. No large bodies of water were observed. (CONTINUED ON LIC 809C)

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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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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)

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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: EASTER SEALS SOUTHERN CALIFORNIA VALLEY HOME	FACILITY NUMBER: 197607709
	VISIT DATE: 07/16/2026

NARRATIVE

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First aid kit and fire extinguishers last reviewed on 2/20/26 were observed.
Operational Requirements: Facility has a fire clearance. Surety Bond and liability insurance in place.
Staffing: Two staff were observed during the visit. Facility is vendorized with Lanterman Regional Center and maintain a 1:3 ratio.
Personnel Records - Training: All staff records were available for review. Each staff has a criminal background clearance. Administrator certificate was observed for Sabrina Godinez #7001795735 exp. date: 08/01/27. TB/HIV training on file. Four staff files were reviewed which included health screenings, TB test clearance, personnel records, finger clearance, and yearly training.
Client Rights - Information: Clients’ rights were reviewed with the clients during council meeting on 6/17/26. A device with internet access is available. Postural support physician's request was observed for client #3(C3) who has half bed rails in the bed.
Food Service: Sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Clients have special diets and facility maintains a menu for their special diets.
Client Records - Incident Reports: All client records were available for review. Files were reviewed for 3 clients, which included medical assessments, admission agreement, individual service plan or needs and care plan, and TB test.
Health-Related Services: Medications were observed centrally stored. A staff assists clients with medication and PRN medications. Staff log to track PRN medication intake. Staff have current First Aid/CPR training on file and are responsible for contacting emergency services. Facility maintains a plan per client to assist with their care and supervision. Medication was reviewed for 3 clients.
Incidental Medical Services: Facility assist clients with medications only. Facility health currently does not have any clients with restricted service plan on file.
Disaster Preparedness: Emergency Disaster Plan LIC610D (12/21) was observed and last reviewed on 01/10/26. Last emergency drill was conducted on 6/13/26 and are conducted monthly.

LPM interviewed 2 clients and 3 staff. LPA reviewed P&I for 3 clients. Three clients have aged in place administrator will resubmit age exception request to the department for reviewed that were previously mailed on May 2026.

No deficiencies were noted during this visit. Exit interview was conducted with Sabrina Godinez Director and copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC809 (FAS) - (06/04)

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