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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561704040
Report Date: 03/12/2026
Date Signed: 03/12/2026 01:47:20 PM

Document Has Been Signed on 03/12/2026 01:47 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: 22DATE:
03/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Martha ShapiroTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one year annual inspection today at 09:15 a.m. Upon arrival, the LPA met with staff who then contacted the Director of Programs to inform them of the visit. The Director of Programs, Martha Shapiro arrived during the inspections and at this time, the reason for the visit was explained. Entrance interview.

At 09:43 a.m., the LPA along with the Director of Programs toured the physical plant inside and outside 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 10:00 a.m. to 2:00 p.m. The day program is currently staffed appropriately with the necessary staff to consumer ratios.

There are six (6) bathrooms for participant use. The LPA inspected the bathrooms and observed them to be clean and in sanitary condition. The bathrooms were sufficiently stocked with soap and paper towels. Starting at 09:52 a.m., the hot water temperature was tested in participant bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the visit.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2026
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SENIOR CONCERNS ADULT DAY SUPPORT CENTER
FACILITY NUMBER: 561704040
VISIT DATE: 03/12/2026
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Continued from LIC 809...

The LPA observed the common areas and a kitchen/food service area. Kitchen appliances appeared to be in operable condition. The LPA observed participants lunch and snacks in the refrigerator; properly stored. 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. There were no obstructions and/or tripping hazards observed. Cleaning supplies are kept locked and inaccessible to participants. The LPA observed required postings throughout the common space. No bodies of water noted at the time of the visit.

The LPA reviewed participant records and staff records starting at 10:40 a.m. Five (5) participant files were reviewed for, but not limited to, the following: signed admission agreements, medical assessments with TB results, Consent for Treatment form, and updated needs and service plan. All participant files were in order. Five (5) staff files including the current Director of Program’s file were reviewed for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification and yearly training. All files were complete.

During today's visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last emergency disaster training was conducted 02/17/2025. There are several fire extinguishers throughout the facility; they were all fully charged and were last serviced on 05/15/2025. The last Fire & Life Safety Inspection was completed on 05/23/2025 and was found to be in compliance with Fire Code Regulations at the time of inspections.

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

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC809 (FAS) - (06/04)
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