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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201213
Report Date: 01/07/2025
Date Signed: 01/07/2025 06:11:13 PM

Document Has Been Signed on 01/07/2025 06:11 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:NEW BEGINNINGS ADULT FACILITY LLCFACILITY NUMBER:
079201213
ADMINISTRATOR/
DIRECTOR:		OYEWUSI, ENIBOKUNFACILITY TYPE:
735
ADDRESS:1304 C ST.TELEPHONE:
(510) 229-0253
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 6CENSUS: 2DATE:
01/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:40 PM
MET WITH:Enibokun Oyewusi, AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
NARRATIVE
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On 1/7/2025 at 5:40pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 1/6/2025. LPA met with Enibokun Oyewusi, Administrator and explained the purpose of the visit.

The incident of missed medication occurred on 1/1/25 and 1/2/25. Administrator stated the pharmacy did not send enough medication for C1. The pharmacy made a mistake by only putting one (1) tablet in the bubble pack instead of two (2). Administrator did not realize at the time of receipt. On today's date Administrator went and picked up additional medication for C1.

The deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of the appeal rights and this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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 2
Document Has Been Signed on 01/07/2025 06:11 PM - It Cannot Be Edited


Created By: Laura Hall On 01/07/2025 at 05:49 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NEW BEGINNINGS ADULT FACILITY LLC
FACILITY NUMBER: 079201213

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2025
Section Cited
CCR
80075(b)(5)(B)

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(b) Clients shall be assisted as needed with self-administration of... medications. (5)... facility staff designated by the licensee shall be permitted to assist the client with self -administration... (B) Once ordered by the physician the medication is given according to the physician's directions.
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Administrator agreed to implement a plan to make sure mediation is being administered and available to clients, and submit plan to CCLD by POC date.
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This requirement was not met as evidence by:
Based on interview the Licensee did not comply with the section cited above in administrating medication by doctor's orders, which poses a potential health and safety risk to persons in care.
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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.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:Laura Hall
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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