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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005713
Report Date: 05/29/2026
Date Signed: 05/29/2026 05:14:36 PM

Document Has Been Signed on 05/29/2026 05:14 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DANIEL RESIDENTIAL CARE HOME LLCFACILITY NUMBER:
347005713
ADMINISTRATOR/
DIRECTOR:		DIALA, JOYCEFACILITY TYPE:
740
ADDRESS:4295 AMAPOLA WAYTELEPHONE:
(916) 717-3263
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 4DATE:
05/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:57 AM
MET WITH: Joyce DialaTIME VISIT/
INSPECTION COMPLETED:
02:36 PM
NARRATIVE
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On 05/29/2026, Licensing Program Analyst (LPA) Pang Lee conducted an annual inspection at Daniel Residential Care Home, LLC. Upon arrival, LPA Lee met with care staff Helen Agbiriogu and requested that she notify the facility Administrator Joyce Diala that Community Care Licensing Division (CCLD), LPA Lee were present to conduct the inspection. Care staff Agbiriogu assisted with the inspection. Approximately two and 30 minutes later, Administrator Diala arrived at the facility.

LPA Lee and care staff Agbiriogu toured the physical plant to assess the health and safety of residents in care. Areas inspected included, but were not limited to, the kitchen, resident bedrooms, resident bathrooms, living room, dining room, and outdoor areas. During the inspection, LPA Lee observed that the facility was free of odor; however, facility was not maintained in a clean and sanitary condition. Several dining room chairs were observed with incontinence pads covering the seats. The pads appeared soiled, dirty, and unsanitary, creating a potential health and sanitation concern for residents. LPA Lee also observed that the emergency exit gate was difficult to open and not maintained in good repair. LPA Lee observed that all resident bedrooms were equipped with the required furnishings and adequate lighting. The facility maintained a public telephone in the common area and had the required postings displayed. The thermostat measured 73 degrees Fahrenheit, which is within the required range of 68 to 85 degrees Fahrenheit.

During the kitchen inspection, LPA Lee observed two kitchen knives stored in an unlocked dishwasher, making them accessible to residents. In the laundry room, which was unlocked and later observed standing open, LPA Lee observed toxin and a knife made accessible in the laundry room. Multiple paint cans were also observed in the garage.

CONTINUED LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2026
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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Document Has Been Signed on 05/29/2026 05:14 PM - It Cannot Be Edited


Created By: Pang Lee On 05/29/2026 at 11:40 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above knives and chemical were made accessiable to residents incare, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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During today's visit, staff removed the knives and chemicals. Administrator will also review the regulation cited and provide LPA Lee with a statement of acknowledgement of reviewing and understanding the regulation cited. POC due by 06/05/2026 end of day 5:00 PM

Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/29/2026 05:14 PM - It Cannot Be Edited


Created By: Pang Lee On 05/29/2026 at 11:40 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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sed on observations and interview the licensee did not comply with the section cited above. LPA Lee observed that the facility was not in sanitary condition. Several dining room chairs were observed with incontinence pads covering the seats. The pads appeared soiled, dirty, and unsanitary, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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During today's visit care staff removed the pads. Administrator will also review the regulation cited and provide LPA Lee with a statement of acknowledgement of reviewing and understanding the regulation cited. POC due by 05/30/2026 end of day 5:00 PM
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. THree staff file review showed that all three staff did not have 20 hours of continual training in the files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Administrator will ensure that all care staff are trained with 20 hours of continual annul trainings. Administrator will also review the regulation cited and provide LPA Lee with a statement of acknowledgement of reviewing and understanding the regulation cited. POC due by 05/30/2026 end of day 5:00 PM
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713
VISIT DATE: 05/29/2026
NARRATIVE
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Because both the laundry room and garage doors were unlocked, hazardous items, including sharp objects and toxic substances, were readily accessible to residents. LPA Lee advised Administrator Diala that all knives, toxins, and hazardous materials must be stored in a locked location and remain inaccessible to residents at all times. Medication storage was inspected and found to be locked and inaccessible to residents. The hot water temperature in the resident bathroom measured 106.3 degrees Fahrenheit, which is within the required range of 105 to 120 degrees Fahrenheit. The facility maintained the required seven-day supply of nonperishable food and two-day supply of perishable food. Fire extinguishers, smoke detectors, and carbon monoxide detectors were observed to be in compliance. The fire extinguisher was purchased on 12/10/2025, and proof of purchase was attached. Grab bars in the bathrooms were observed to be secure and in good repair. The resident shower contained a textured non-slip shower base; however, testing revealed that the surface had become slippery due to deterioration of the texture. LPA Lee advised the facility to have additional non-slip mats to reduce the risk of falls.

While inspecting the courtyard, LPA Lee observed three garbage bags filled with recyclable water bottles, a television, an exercise machine, and two tables stored along the side of the facility. Although these items did not completely block the emergency exit gate, they partially obstructed the pathway and could impede emergency access if emergency medical services were needed. LPA Lee advised Administrator Diala that all emergency exits and pathways must remain clear and unobstructed at all times. Administrator Diala stated the items would be removed. During the inspection, LPA Lee learned that the facility is fire-cleared for non-ambulatory residents in bedrooms 1 and 3, while bedroom 2 is approved for ambulatory residents only. Based on records reviewed and interviews conducted with care staff Agbiriogu and Administrator Diala, Resident 1 (R1) resides in bedroom 2. According to R1’s LIC 602 Physician’s Report dated 05/15/2025, R1 is non-ambulatory and should not be in room 2 as room 2 is not fire cleared for non-ambulatory residents. Administrator Diala stated that R1 was previously sharing bedroom 3 with another resident; however, resident 2 (R2) complained about R1 was taking their belongings, resulting in R1 being moved to bedroom 2. As a result, the facility is operating outside of its approved fire clearance by housing a non-ambulatory resident in a room designated for ambulatory residents only. Per Adiministrator Diala, R1 will be moved back to room 3.

LPA Lee conducted a medication audit for four of four residents by comparing medications on hand to the Medication Administration Records (MARs). The medication review revealed discrepancies.

CONTINUED LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC809 (FAS) - (06/04)
Page: 7 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713
VISIT DATE: 05/29/2026
NARRATIVE
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 R2 had two PRN medications, Melatonin 3 mg and Equate Stool Softener 100 mg, stored in the resident's medication container. According to the MAR, both medications were administered from 05/01/2026 through 05/28/2026; however, the facility was unable to provide physician orders authorizing the use of these medications. LPA Lee reviewed four of four resident files and found them to be complete. Three staff files were also reviewed and found to be incomplete. Based on interviews with Administrator Diala, the facility was unable to provide documentation showing that 20 hours of continual staff training was completed during calendar year 2025. Additionally, a review of staff records revealed that two staff members had expired First Aid/CPR certifications. One certification expired on 07/17/2023 and the second expired on 04/21/2026.

The following documents will be email to LPA by 06/5/2026 end of day 5:00 PM:



(1) LIC 308 Designation of Administrative Responsibility
(2) Copy of Administrator Certificate
(4) LIC 610 Current Emergency Disaster Plan
(5) Proof of Current Liability Insurance
(6) LIC 500 Current Personnel Report


An immediate penalty was assessed today in the amount $500 due to 87204 Limitations - Capacity and Ambulatory Status.

As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with Administrator Diala and a copy of these LIC 809 reports, LIC 809-D page, LIC 421 IM and Appeals rights were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 05/29/2026 05:14 PM - It Cannot Be Edited


Created By: Pang Lee On 05/29/2026 at 01:25 PM
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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87204(b)
87204 Limitations - Capacity and Ambulatory Status
(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate non-ambulatory residents. Residents whose condition becomes non-ambulatory shall not remain in rooms restricted to ambulatory residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review and interview, the licensee did not comply with the section cited above. A non-ambulatory resident was residing in a room that was not fire cleared for non-ambulatory residents but for only ambulatory residents, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/30/2026
Plan of Correction
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Administrator will move R1 back to the non-ambulatory room and emailed LPA Lee with proof of moving the resident. Administrator will also review the regulation cited and provide LPA Lee with a statement of acknowledgement of reviewing and understanding the regulation cited. POC due by 05/30/2026 end of day 5:00 PM

Type A
Section Cited
CCR
87465(e)
87465(e) Incidential Medical and Dental Care Services
(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. R2 had two PRN medications in their medication tubs and was being administered the medications without doctor's order, which poses/posses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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Administrator stated that they will ensure that all PRN medications have a doctor's order before being administered to residents in care. Administrator will also call R2's PCP to follow up on the two PRN medications. Administrator will also review the regulation cited and provide LPA Lee with a statement of acknowledgement of reviewing and understanding the regulation cited. POC due by 05/30/2026 end of day 5:00 PM
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 05/29/2026 05:14 PM - It Cannot Be Edited


Created By: Pang Lee On 05/29/2026 at 01:28 PM
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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(3)
§1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following:
(3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Two facility care staff files did not have current certified CPR/First Aid training which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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The facility designated Administrator stated that all facility staff providing care and supervision to the residents in care will be updated for training and be current in First Aid certification at all times. A statement of correction, along with copies of the updated First Aid certificates, will be completed and submitted into CCL by the due date 06/12/2026 end of day 5:00 PM.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
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