197608636-12-7-2023-31-AS-CALH-CYB2LN-20231207162948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608636
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:30:57 PM

Document Has Been Signed on 12/07/2023 04:30 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:	ROYAL TRINITY ENRICHMENT CENTER		FACILITY NUMBER:	197608636
ADMINISTRATOR:	BERNARD MOSES ISIKO		FACILITY TYPE:	735
ADDRESS:	13142 CROWLEY STREET		TELEPHONE:	(818) 394-9745
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY: 6		CENSUS: 6	DATE:	12/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Bernard Isiko		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/07/2023 at 02:00 PM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – 1 Year Inspection at Royalty Trinity Enrichment Center and met with staff (S1) Administrator Bernard Isiko (S2) Assistant Faith Isiko. LPA’s Temperature was checked upon entry and signed in the sign in sheet. LPA explained the purpose of the visit and were accompanied by S1 and S2 inside and outside the facility during this inspection. Facility temp measured at 72 degrees The facility consists of 3 client bedrooms, 1 staff bedroom, 2 bathrooms, a living room, dining room, laundry room and kitchen. This facility is licensed to serve 6 adults ages 18 – 59 years. A total of 6 clients are currently residing in this facility, 6 out of 6 clients are ambulatory. A total of 3 staff and 2 clients were present during this inspection. Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. 3 out of 3 client’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA Alemoh tested hot water temperature in the middle hallway client restroom, and it measured between 118- and 119 degrees Fahrenheit. This facility provides clients with residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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: ROYAL TRINITY ENRICHMENT CENTER	FACILITY NUMBER: 197608636
	VISIT DATE: 12/07/2023

NARRATIVE

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LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days Located in the garage. Along with facility PPE’s.

Laundry area is in the rear space of the facility. This area was 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.

LPA observed that Medications were safe, locked and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. All Medication are stored in the hallway closet adjacent to the kitchen. Knives are stored in a cabinet under the sink. Documents are posted as mandated. Last Disaster drill was conducted on 10/28/2023. First aid kit is fully stocked with manual is in the middle hallway closet. Smoke and carbon monoxide detectors are hardwired and in compliance and operational. One (1) Fire Extinguishers were observed throughout the facility purchase date is Oct 28th, 2022.

Nine (9) staff records were reviewed, 9 out of 9 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. Six (6) client records were reviewed and, 6 out of 6 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. LPA Alemoh reviewed P&I money, 6 out of 6 residents P&I funds were intact and were not commingled with facility funds or petty cash. All client/resident and staff files are locked in the staff office in black cabinet in the garage inaccessible to residents.

No deficiencies cited.

An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Administrator Bernard Isiko & Faith Isiko.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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