197608194-6-21-2024-31-AS-HRAI-D6FPLY-20240621112531

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608194
Report Date: 06/21/2024
Date Signed: 06/21/2024 11:26:07 AM

Document Has Been Signed on 06/21/2024 11:26 AM - 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:	AMIGO HOME CARE, INC.		FACILITY NUMBER:	197608194
ADMINISTRATOR:	UGORJI ONYIKE		FACILITY TYPE:	735
ADDRESS:	7438 AMIGO AVE		TELEPHONE:	(818) 881-6848
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	4	CENSUS: 4	DATE:	06/21/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ugorji Onyike, Administrator		TIME COMPLETED:	12:00 PM

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At 9:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by the Staff, Victor Ugorji, who granted access to the facility. Administrator, Ugorji Onyike, arrived shortly after and LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following:

It is a single-story building with three (3) bedrooms, two (2) bathrooms, a staff room, kitchen, living room, dining room, garage, and outdoor areas. It has an approved fire clearance for 4 ambulatory residents.

Kitchen: At 09:05 AM, LPA and Administrator toured the kitchen and LPA observed an adequate supply of perishable and non-perishable food. LPA observed a complete first aid kit hung on the kitchen wall. The house phone was located in the kitchen as well. Facility files and consumer medication were locked near the dining room. Weekly menu was posted. At 09:10 AM, LPA observed a fully charged fire extinguisher in the kitchen and was purchased on 06/21/2024.

Living/dining: All indoor passageways were free from obstruction; with adequate lighting, walls, floors, ceilings, windows, screens and blinds were clean and in good repair. All areas were clean and appropriately furnished for client's comfort. At 09:15 AM, LPA measured the room temperature to be 74.0 degrees Fahrenheit. fireplace is adequately screened.

Bedrooms: At 09:20 AM, LPA observed three bedrooms designated for clients. Room # one (1) is used for an office. Room # three (3) is shared. Room # two (2) and room # four (4), are private. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.

Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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: AMIGO HOME CARE, INC.	FACILITY NUMBER: 197608194
	VISIT DATE: 06/21/2024

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Bathrooms: The facility has two(2) bathrooms. Bathroom # one (1) is shared and was located next to the office. Bathroom # two (2) was located in the bedroom # three (3). It contained liquid soap, paper towels, a handwashing instruction sign, a trash can with a lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 09:25 AM, LPA measured the water temperature in the bathroom to be 111.7 degrees Fahrenheit.

Garage: The garage was locked and contained a washer, dryer, and extra PPE supplies. Machines were in good condition. Detergent was locked in a standing cabinet. All knives and sharps observed to be locked in a standing cabinet and inaccessible to clients in care inside the garage. There was a bathroom available for staff use only.

Safety: All emergency exit paths were free from obstructions. Two (2) out of (2) exit gates were unlocked with inward facing latches. Exit routes were clearly labeled.

Outdoor areas: LPA observed a covered patio with appropriate furniture, and a gas grill outside. All areas were clean and free from debris. There is no pool or any bodies of water at the facility.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:05 AM, they were tested and observed to be operational. Carbon monoxide was located in the living room and was also tested and observed to be operational.

Between 9:50 AM to 11:00 AM, LPA reviewed records of four (4) clients and three (3) staff. Clients and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, Surety Bond Certificate, and LIC.500.

No deficiencies cited during today's visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

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