197600256-3-8-2024-31-AS-MCAA-D36RSK-20240308121653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600256
Report Date: 03/08/2024
Date Signed: 03/08/2024 12:17:03 PM

Document Has Been Signed on 03/08/2024 12:17 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	EUNICE HOME		FACILITY NUMBER:	197600256
ADMINISTRATOR:	AGBEDE, SONNY		FACILITY TYPE:	735
ADDRESS:	11611 BALBOA BLVD.		TELEPHONE:	(818) 368-9242
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 6	DATE:	03/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Sonny Agbede, Cherish Abati		TIME COMPLETED:	12:20 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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Cherish Abati and explained of the reason for the visit. The administrator, Sonny Agbede was advised over the telephone. He arrived at the facility shortly. At approximately 9:15am, with the assistance of staff, LPA took a tour of the physical plant. The smoke alarms are hardwired and interconnected. The carbon monoxide detector functions properly. The fire extinguisher is located at the family room, by staff workstation. The charge date is 05/18/2023. Earthquake, fire and emergency drill drill was last conducted in November 2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored and inaccessible to residents in care. LPA did not observe any cleaning supplies and toxins present in the kitchen area. Bedrooms: There are four (4) bedrooms designated for residents' use. Two were for private use and two are shared. Each bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. There is a locking mechanism on the outside doorknobs of each resident's room to keep for privacy. It requires a combination code to gain entry from the outside. No combination code needed from the inside of the room to exit. Resident's are able to exit their rooms without any obstruction. Locking mechanism approved by Regional Center. Bathrooms: There are two and a half (2 1/2) bathrooms in the facility. Two bathrooms are designated for residents, and the half bathroom, which only consists of a toilet and sink, is for staff only. The two bathrooms, designated for the resident's use, were properly supplied and had functional fixtures. Hot water temperature was measured at 111 degrees Fahrenheit. No cleaning supplies were observed in the bathroom.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: EUNICE HOME	FACILITY NUMBER: 197600256
	VISIT DATE: 03/08/2024

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
26
27
28
29
30
31
32

Common Areas: These included the living room, family room and dining area. The common areas were properly furnished. The furniture were in good repair, and the floors were mopped and clean. The dining room table was large enough to seat six (6). There are two fireplaces, one in the living room and one in the family room. Both are non-functional. The fireplace in the living room was properly screened, while the one in the family room was boarded up. Exit to the backyard from the living room and family room were clear.

Surrounding Grounds: Entry/exits were free of obstruction. There is backyard furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located outside. No detergents or toxins were observed accessible in the laundry area. The garage is located at backyard. It was converted into storage space for cleaning supplies and equipment. It is kept locked and inaccessible to the residents.

Staff workstation/office: There is a staff work station located at the corner of the family room where medications are stored and maintained. Medications and medication records were observed locked and inaccessible to clients in care. Client and staff records were also maintained in the staff work station.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2