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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561704040
Report Date: 03/13/2025
Date Signed: 03/13/2025 02:47:36 PM

Document Has Been Signed on 03/13/2025 02:47 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SENIOR CONCERNS ADULT DAY SUPPORT CENTERFACILITY NUMBER:
561704040
ADMINISTRATOR/
DIRECTOR:		ANDREA GALLAGHERFACILITY TYPE:
775
ADDRESS:401 HODENCAMP RDTELEPHONE:
(805) 497-0189
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 75CENSUS: 20DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Martha ShapiroTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one year annual inspection today. The last annual conducted at this facility was on 03/20/2024. Upon arrival, the LPA met with Director of Programs, Martha Shapiro and the reason for the visit was explained. Entrance interview.

Starting at 10:00AM, the LPA along with the Director of Programs toured the physical plant inside and out to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

The day program operates from 10:00AM to 2:00PM. There are twenty (20) participants present at the day program today. The day program is currently staffed appropriately with the necessary staff to consumer ratios. The facility has several activity rooms, eight (8) bathrooms, a kitchen area, conference room, a staff breakroom, and staff offices.

KITCHEN: At 10:12AM, the LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked.

BATHROOMS: There are eight (8) bathrooms within the facility. The LPA inspected the bathrooms for cleanliness, restrooms were clean, and trash cans have lids to protect participants from cross contamination. The bathrooms were sufficiently stocked with soap and paper towels. Appropriate hand-washing signs were observed in all bathrooms. Starting at 10:05AM, the hot water temperature was tested and was within the required range of 105 - 120 degrees Fahrenheit at the time of the visit.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SENIOR CONCERNS ADULT DAY SUPPORT CENTER
FACILITY NUMBER: 561704040
VISIT DATE: 03/13/2025
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Report Continued from LIC 809...

COMMON AREAS: These include the program areas, dining room, and outdoor patio. The common areas were furnished appropriately, and all furniture was observed to be in good condition at the time of the visit. Facility maintained at a comfortable temperature. Activities are designed for both as individuals and as a group. The LPA observed staff interacting with participants during the inspection. The delayed egress doors were tested during today's visit and were operational. The LPA observed storage room with additional activity supplies and cleaning supplies locked and inaccessible to participants at the time of the visit. The LPA observed required postings throughout the common space. There were no obstructions and/or tripping hazards observed. No bodies of water noted at the time of the visit.

RECORDS REVIEW: The LPA reviewed participant records and staff records starting at 10:45AM.

Six (6) participant files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, and needs and service plan. All participant files were in order.

Six (6) staff files were reviewed for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification and required yearly training. All files were complete.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, the LPA reviewed the facility's infection control policy. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency and disaster plan, which was observed to be complete and recently reviewed/updated. There are several fire extinguishers throughout the facility; they all were fully charged and last serviced on 06/10/2024.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SENIOR CONCERNS ADULT DAY SUPPORT CENTER
FACILITY NUMBER: 561704040
VISIT DATE: 03/13/2025
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Report Continued from LIC 809C...

The last fire safety inspection was completed on 04/16/2024 and was found to be in compliance with Fire Code Regulations at the time of inspections. The 5 year Fire Sprinkler System inspection was also completed on 08/21/2024 with no corrections needed. Emergency disaster drills conducted quarterly as per regulation; the last drill was conducted on 01/08/2025.

MEDICATIONS: Medications review began at approximately 1:35PM. Medications are centrally stored and kept locked and inaccessible in the medication room. There are currently four (4) participants requiring medications during the day program. Staff is utilizing a Medication Administration Record (MAR) for documentation purposes. Medications appeared to be given as prescribed at the time of the visit.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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