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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601032
Report Date: 11/04/2022
Date Signed: 11/04/2022 12:14:03 PM

Document Has Been Signed on 11/04/2022 12:14 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 IIFACILITY NUMBER:
197601032
ADMINISTRATOR:AGBEDE, SONNYFACILITY TYPE:
735
ADDRESS:17131 COURBET STREETTELEPHONE:
(818) 831-5282
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sonny AgbedeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. The LPA had his temperature taken and all covid 19 questions were asked prior to allowing the LPA enter the home. The administrator was called and arrived a short while later. The LPA explained that this was an Infection Control Annual.

The Inspection Tool was used to conduct the annual. The home has 5 bedrooms and 4 bathrooms. The Smoke alarms are not hard wired but LPA tested all smoke alarms in the home and they all functioned properly. The carbon monoxide detector was also tested and functioned properly. The fire extinguisher was observed next to the kitchen and was last serviced on 4/29/2022.

The facility is following their infection control plan and no deficiencies were observed during the visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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