197604417-1-16-2024-31-AS-HRAI-CZJSB8-20240116124332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197604417
Report Date: 01/16/2024
Date Signed: 01/16/2024 12:44:33 PM

Document Has Been Signed on 01/16/2024 12:44 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	EL-SHADDAI'S HOME II		FACILITY NUMBER:	197604417
ADMINISTRATOR:	COLLINS AKINSOLA		FACILITY TYPE:	735
ADDRESS:	18915 LANARK STREET		TELEPHONE:	(818) 886-1364
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 6		CENSUS: 4	DATE:	01/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Collins Akinsola, Administrator		TIME COMPLETED:	01:00 PM

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At approximately 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPA called the Administrator, Collins Akinsola, to grant access to the facility for the annual inspection. LPA waited outside of the facility. Administrator arrived at 10:20 AM, and LPA was granted access to the facility for the inspection. At 10:25 AM, Physical tour was conducted with the Administrator and LPA observed the following:

Census: 4

Kitchen: At 10:26 AM, LPA observed clean floors, walls, and ceilings in the kitchen and dining area. LPA observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility.

Garage: LPA observed an adequate supply of PPE in the garage along with operable laundry machines. Emergency exits were unlocked and free from obstruction. All knives and cleaning materials were in a locked shed.

Bedrooms: At 10:32 AM, LPA observed total of four (4) bedrooms. Bedroom # one (1) is shared. Bedroom # two (2) and bedroom # three (3) are for private use. Bedroom # 4 is for staff which was at the end of the hall and LPA observed to be clean and locked all the times when not attended. There are no live-in staff in the facility. All bedrooms are properly furnished, clean and have appropriate bedding and linens with furniture in good repair.

Bathrooms: The facility contained 2 bathrooms. One bathroom was inside the shared bedroom. That bathroom contained paper towels, a trash can, and liquid soap under the sink. The other bathroom was near the front entrance and contained paper towels, a trash can, a handwashing instruction sign. LPA observed both bathrooms to be clean and in good repair. At 10:38 AM, hot water temperature measured at 107.4°F.

Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: EL-SHADDAI'S HOME II	FACILITY NUMBER: 197604417
	VISIT DATE: 01/16/2024

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Dining Room: At 10:40 AM, LPA observed a fully charged fire extinguisher purchased on 01/08/2024, and a first aid kit near the kitchen. A medication cabinet with client medications was locked. LPA also observed postings for client personal rights, and activity schedule, house rules, grievance procedures, and a confidential complaint hotline.

Common Areas: At 10:45 AM, LPA observed that the facility maintains a comfortable temperature at 69°F. The living room and dining area appeared clean and were properly furnished. All furniture was in good repair. The living room has a television. No obstructions and or tripping hazards throughout the facility.

Other areas: LPA observed a closet in the hallway with an adequate supply of clean linens. LPA observed a locked closet near the entrance with facility files.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:50 AM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational.

Outside areas: At approximately, 10:55 AM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA observed a locked storage for tools and paints.

Between 11:15 AM to 12:30 PM, LPA reviewed records of four (4) clients and three (3) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

No deficiency cited during today’s visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

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