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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602390
Report Date: 10/03/2025
Date Signed: 10/03/2025 05:54:23 PM

Document Has Been Signed on 10/03/2025 05:54 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:DANIELLA'S HOMEFACILITY NUMBER:
198602390
ADMINISTRATOR/
DIRECTOR:		COELLO, BESSIE LFACILITY TYPE:
740
ADDRESS:18005 OSAGE AVENUETELEPHONE:
(310) 371-4088
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: 4DATE:
10/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:Bessie CoelloTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 10/03/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit using the full CAREs tool. The department met with Administrator, Bessie Coello, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, one of which may be bedridden, and an approved hospice waiver for two (2). Currently there are four (4) residents residing in the facility.
Structure/Physical Plant The facility is a two-story structure in a residential neighborhood. The facility consists of 4 bedrooms, 2 ½ bathrooms, family room, living room, kitchen, dining room, indoor activity room, outdoor activity area, laundry room, front yard, and backyard. There is a shaded patio with table and chairs. The department observed a fenced pool on the premises. All walkways around the facility were observed to be clean, clear, and free of obstructions, hazards, and debris.
Bedrooms LPA inspected all residents’ rooms and found them to be clean and in good repair. All rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed all beds to have the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. LPA observed an ample supply of linens in resident rooms. All bedrooms have ample lighting.
Bathrooms LPA inspected all bathrooms and found them to be within Title 22 regulations. All bathrooms were observed clean and operational. LPA observed an adequate supply of towels and personal hygiene supplies. Secured handrails and non-skid mats were observed in showers.
Kitchen LPA observed the kitchen to be clean and sanitary. All appliances were tested and found to be in good working repair. LPA observed an ample supply of cutlery, cookware, and dishware in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. A sample menu was posted on the refrigerator. All sharps were observed secured in a locked drawer in the kitchen and are inaccessible to resident. All cleaning supplies were observed secured in a locked cabinet in the activity room
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2025
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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DANIELLA'S HOME
FACILITY NUMBER: 198602390
VISIT DATE: 10/03/2025
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and are inaccessible to residents. The water temperature measured 110.1-degrees Fahrenheit.
Common Rooms In the living room, LPA observed two couches and chairs for client use. In the family room, LPA observed a couch available for residents. LPA observed games and activities in the family room. The dining room has a large table and chairs to accommodate all residents. In the activity room, LPA observed tables and chairs available for residents. LPA observed games, activities, and crafts available for residents. LPA observed all walkways and hallways to be clean, clear, and free of obstructions and hazards. All rooms were observed with ample lighting. The facility was maintained at a comfortable temperature.
Safety Smoke and Carbon Monoxide Detectors are in compliance and are operational. LPA observed two fully charged fire extinguishers last serviced on 08/22/25. The last Fire Prevention Inspection was conducted by the Torrance Fire Department on 11/22/2024. The last emergency drill was conducted on 10/01/25. The First Aid Kit was inspected and found to contain all required items and a current manual. The facility has a working landline telephone. LPA observed all required documents posted throughout the facility. There are no firearms or ammunition stored on the premises.
Files LPA reviewed four (4) resident files and found they contained the required documents. LPA reviewed residents P&I and observed records are consistent with receipts. LPA reviewed the administrator and three (3) staff files and found they contained the required documents, clearance, certification, and training. The administrator’s Administrator Certificate is valid till 01/04/27. During file review LPA observed all licensing fees are current. LPA received and reviewed the liability insurance through Acord that is valid till 10/23/25. LPA reviewed the surety bond through Summa Insurance that is valid till 07/15/2028.
Medications LPA observed centrally stored medication secured in a locked cabinet in the activity room and are inaccessible to residents. LPA observed medications in their original packaging. LPA reviewed the medications and medication administration record (MAR) for four (4) residents and found them to consistent with properly documented records.
Infection Control LPA observe the facilities infection control procedures. LPA observed a sanitizing station at the entrance of the facility. All required infection control signs were posted throughout the facility. The facility has a 30-day supply of PPEs.

During today’s visit no deficiencies were observed or cited.

An exit interview was conducted with Administrator, Bessie Coello, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
LIC809 (FAS) - (06/04)
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