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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601032
Report Date: 12/13/2024
Date Signed: 12/13/2024 12:55:21 PM

Document Has Been Signed on 12/13/2024 12:55 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/
DIRECTOR:
AGBEDE, SONNYFACILITY TYPE:
735
ADDRESS:17131 COURBET STREETTELEPHONE:
(818) 831-5282
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 2DATE:
12/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Eniola ArowaramimiTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Eniola Arowaramimi, and explained the reason for the visit.

At approximately 9:30am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. The smoke and carbon monoxide alarms are tested and observed to be operable during the visit. Both are battery operated. There is a fully charged fire extinguisher located at the medication room, located by the dining room and kitchen area.

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 and cleaning supplies were stored inaccessible from the residents.

Bedrooms: There are five (5) bedrooms. Four (4) bedrooms designated for residents' use. Two (2) rooms are private, and two (2) are shared. The fifth (5th) room is used as an office. The four (4) bedrooms, in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are four (4) bathrooms. Three (3) of the bathrooms were designated for residents' use, and one (1) is designated for staff. Bathroom in use for the residents were properly supplied and had functional fixtures. Hot water temperature was measured between 107 to 112 degrees Fahrenheit.

Common Areas: These included the living room, family room and dining area. The living room had three recliners, coach and television. The family room had recliners and a round table. There is a fireplace in the family room that was properly screened. It is not in use, and no fireplace tools were present. Furniture was in good repair. Floors were mopped and cleaned. No hazard present.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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 II
FACILITY NUMBER: 197601032
VISIT DATE: 12/13/2024
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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The swimming pool was in between a fence, that was at least five feet high, and a wall at the opposite end. The gate, to enter the pool area was observed to be locked. The outdoor area was free of any hazards.
Garage: The garage is used for storage and laundry area. Cabinets where cleaning supplies and detergents are kept is locked.

Staff Office/Work Station: The facility has both a staff office and a staff work station. Staff office is located by the front entrance. It was locked during the visit. LPA conducted an inspection inside and observed a couch, desk, monitor, printer and copying machine inside this room. The work station is located near the dining room and kitchen area. Resident and staff records are maintained locked in a cabinet there. Medications are also kept locked in this area.

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 compliance.

Medications: Medication and Medication Records were reviewed for appropriate locked storage and documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observe during the day's visit. Exit Interview Conducted and a copy of this report was issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC809 (FAS) - (06/04)
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