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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208981
Report Date: 09/19/2022
Date Signed: 09/19/2022 01:12:14 PM

Document Has Been Signed on 09/19/2022 01:12 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:OPOKU RESIDENTIAL CARE #2FACILITY NUMBER:
107208981
ADMINISTRATOR:OPOKU-ABABIO, KOFIFACILITY TYPE:
735
ADDRESS:679 E KEATS AVETELEPHONE:
(559) 475-4057
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 4CENSUS: 1DATE:
09/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Kofi Opoku-Ababio, AdministratorTIME COMPLETED:
01:25 PM
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Licensing Program Analysts (LPAs) Vadim Gorban and Lady Cabrera conducted an unannounced Case Management visit. LPAs met with Kofi-Opoku-Ababio regarding Unusual incident report that occurred on 01/24/2022 to follow-up regarding Client’s (C1) health and safety. LPA requested further information. Administrator will submit C1’s records by 09/27/2022 to CCL. Administrator reported C1 was discharge from the facility.

CCL Office received Unusual Incident/Injury Report (SIR) dated 05/24/2022 and 06/03/2022 regarding C2 to follow-up regarding C2's health and safety. No follow-up needed. Staff is providing supervision.

CCL Office received SIR dated 05/12/2022 regarding C3 to follow-up regarding C3's health and safety. LPA requested further information. Administrator will provide C3’s records by 09/27/2022 to CCL via email.

Exit interview conducted and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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