107208970-9-5-2024-24-AS-DBOD-D8TVVH-20240905164623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107208970
Report Date: 09/05/2024
Date Signed: 09/05/2024 05:53:45 PM

Document Has Been Signed on 09/05/2024 05:53 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	OPOKU RESIDENTIAL CARE		FACILITY NUMBER:	107208970
ADMINISTRATOR:	KOFI OPOKU-ABABIO		FACILITY TYPE:	735
ADDRESS:	671 E KEATS AVE		TELEPHONE:	(559) 353-2649
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	4	CENSUS: 4	DATE:	09/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Kofi Opoku-Ababio		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit and granted entry by Staff. Staff then called Administrator, Kofi Opoku-Ababio so he could return to the home to complete the inspection. LPA toured facility with Administrator. No clients were present during the inspection. The tour started in the kitchen into the common areas, to the client's bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of degrees 78 degrees F and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was not observed. Administrator had staff go shopping to meet regulatory standards. Emergency food supply was expired and staff pulled food out to dispose of and replace. Cleaning supplies and chemicals stored and locked in a hall closet. Medications observed loose and unorganized and kept locked in the dining area in a file cabinet. All bedrooms were observed to have required bedding, Client #2 room missing window coverings and a window screen. Broken dresser drawers observed in client #4 room. All rooms had adequate lightening. LPA observed four single occupant rooms. Bathrooms did not contain hand soap or towels. Toilet paper holders and towel bars were broken off of the walls, leaving holes in the wall. Hot water temperature was tested at 107 degrees F. Fire extinguisher was observed with a service date of 2/14/2024. Fire drill last completed on 03/24. Outside of facility toured and observed to be free of debris. Two gates exiting the backyard did not easily open or close. Outside area contained no furnishings for clients to sit outside. Carbon monoxide and smoke detectors were tested and observed to be operational. Staff files were missing documentation as noted on LIC812 attached. Client files were missing documentation as noted on LIC812 attached. First Aid checked and fully stocked. A detailed list of items that need to be fixed and/or addressed by Licensee is attached on an LIC812. Con't on next page

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Daiquiri Boyd	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: OPOKU RESIDENTIAL CARE	FACILITY NUMBER: 107208970
	VISIT DATE: 09/05/2024

NARRATIVE

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LPA observed the home to be in need of a general cleaning, including inside of pantry and cabinets. Hole in the wall next to front door to be repaired.

LPA issued citations on this day for Physical Plant

TSP is being offered to Licensee on this day and Licensee agrees to this suggestion by LPA.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by Administrator. Forms requested: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, LIC 601, LIC 613C, consent form and control of property will be submitted by 09/19/2024 . A copy of this report was provided to the Licensee, whose signature on this form confirms receipt of this report.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Daiquiri Boyd	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/05/2024 05:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: OPOKU RESIDENTIAL CARE	FACILITY NUMBER: 107208970
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as the facility is in need of cleaning, update facility sketch, fix exterior gates, clean pantry, fix bathroom fixtures, supply soap and paper towels, repair hole in wall next to the front door, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/19/2024
	Plan of Correction
1 2 3 4	By September 19, 2024, Licensee shall repair bathrooms as needed, clean facility as needed including pantry and cabinets in bathrooms and kitchen, supply soap and paper towels in the bathroom, repair hole in wall next to front door, update faciity sketch, supply outside furniture.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sergiy Pidgirny	TELEPHONE: (559) -243-8080
LICENSING EVALUATOR NAME: Daiquiri Boyd	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

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