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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608636
Report Date: 07/26/2022
Date Signed: 07/26/2022 12:45:55 PM

Document Has Been Signed on 07/26/2022 12:45 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:ROYAL TRINITY ENRICHMENT CENTERFACILITY NUMBER:
197608636
ADMINISTRATOR:BERNARD MOSES ISIKOFACILITY TYPE:
735
ADDRESS:13142 CROWLEY STREETTELEPHONE:
(747) 223-2115
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 6CENSUS: DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH: Bernard MosesTIME COMPLETED:
12:48 PM
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Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced annual/infection control visit to this facility at 9:45 am and observed COVID signs on the front door. LPA was greeted by House manager Joy Ouma and temperature was taken and recorded in visitor logbook. The administrator was called and arrived at 10:10 am.
LPA conducted a tour of the physical plant at 10:25 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted:
Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

Facility has five (5) five bedrooms: (4) four bedrooms for clients and (1) bedroom designated for staff. There are three (3) bathrooms: (1) one for clients located in hallway near client’s bedrooms, (1) one near living room for visitors/guest, and (1) one bathroom in employee bedroom. There is no body water in the facility.

Foyer/Office near front door observed to be clean and furniture observed to be in good condition. Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have supply of clean linen.
Bathrooms were observed to be clean and sanitary with necessary supplies and handwashing signs. Hot water temperature ranges at 114.2, 115.5, and 111.8 degrees Fahrenheit..
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition and adequate seating for clients. Wall thermostat observed and set to 77 degrees Fahrenheit. Kitchen area was observed to be clean and sanitary. Sharps are locked in under kitchen sink. Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.

(Cont to 809C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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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: ROYAL TRINITY ENRICHMENT CENTER
FACILITY NUMBER: 197608636
VISIT DATE: 07/26/2022
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( Cont from 809)

Water and additional perishable and non-perishable food stored in garage and in 2nd refrigerator in garage.

Medication are in locked pantry/closet near kitchen and hallway on middle shelves. Medication was observed to be inaccessible to clients. This closet also stores facility files, staff and client records on top shelves. First aid kit located on bottom shelf observed to be fully stocked.



Dual Smoke alarms and carbon monoxide are hardwired and interconnected, were tested and observed to be operable. Fire extinguisher on wall near living room and kitchen observed to be charged. Laundry area is in the garage observed to be clean and appliances in good repair. All the toxins, cleaning solutions and disinfectants are locked in 3-door cabinet above washer and dryer.

There is a patio shaded by a cloth gazebo for clients use in the backyard and a large activities table and chairs in the garage. All observed to be clean and furnished with adequate seating. A sufficient supply of PPE’s are store in cabinets against garage wall. The grounds entry/exits area were clean with and free of obstruction. Received a copy of infection control plan.

There was no immediate health and safety hazard observed during the day of inspection. There are no deficiencies to report.



Exit interview conducted and a copy of this report was given.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022
LIC809 (FAS) - (06/04)
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