197609758-5-23-2026-31-AS-TCAS-DUCPKZ-20260523112358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609758
Report Date: 05/23/2026
Date Signed: 05/23/2026 11:24:39 AM

Document Has Been Signed on 05/23/2026 11:24 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DANIAS SENIOR HOME		FACILITY NUMBER:	197609758
ADMINISTRATOR/ DIRECTOR:	BAEZA, DANIA ELISABETH		FACILITY TYPE:	740
ADDRESS:	22331 COVELLO ST		TELEPHONE:	(747) 226-3342
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY: 6		CENSUS: 6	DATE:	05/23/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Dania Baeza		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

NARRATIVE

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Licensing Program Analysts (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPAs met with the Administrator Dania Baeza and explained the reason for the visit.

A physical plant inspection was conducted of the inside and outside of the facility. The following areas were inspected: Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Kitchen: LPA observed a sufficient supply of non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents Fire extinguisher fully charged. Food storage and preparation areas are clean and inaccessible to pests. Bedrooms: There are four (4) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were operating and tested. (1) room is used for staff. Bathrooms: There are (3) bathrooms. All bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 109.4°F. LPA observed appropriate grab bar and non-skid mat. LPAs observed appropriate hand washing signs posted in each bathroom. .

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and observed to be operational.

(Cont'd LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Tuesday Cabiness
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2026

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: DANIAS SENIOR HOME	FACILITY NUMBER: 197609758
	VISIT DATE: 05/23/2026

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Outside areas: LPA toured the outside area of the facility and observed a clean covered patio and backyard furniture to accommodate residents.

The garage: The detached garage is being used for an extra storage and was observed to be locked. Chemicals were locked and stored. There was an additional refrigerator stocked with food for the facility.

Laundry: Laundry area is located by the kitchen/dining area and was observed to be locked and inaccessible to residents.

Medications: First Aid Kit complete with the required items. Medications are centrally stored, locked in a kitchen cabinet and accessible to residents in care. Medication is being administered according to physician orders.

Record review: Resident records were current and updated. Staff records: Administrator and staff on duty did not have first aid/CPR or current/valid staff training.

Citation issued, appeal rights, exit interview, and copy of report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Tuesday Cabiness
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/23/2026 11:24 AM - It Cannot Be Edited

Created By: Tuesday Cabiness On 05/23/2026 at 10:38 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DANIAS SENIOR HOME	FACILITY NUMBER: 197609758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87412(c)

Personnel Records

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Administrator and staff on duty did not have current staff training in personnel file. Which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/08/2026
	Plan of Correction
1 2 3 4	Administrator has agreed to submit current training for staff by POC date.

Type B

Section Cited

CCR

87411(c)(1)

Personnel Requirements - General

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Administrator and staff on duty did not have current first aid/CPR staff training in personnel file. Which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/25/2026
	Plan of Correction
1 2 3 4	Administrator has agreed to submit first aid/CPR for staff by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:

	Tuesday Cabiness
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2026

LIC809 (FAS) - (06/04)

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