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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608636
Report Date: 08/05/2024
Date Signed: 08/05/2024 05:51:59 PM

Document Has Been Signed on 08/05/2024 05:51 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 CENTERFACILITY NUMBER:
197608636
ADMINISTRATOR/
DIRECTOR:		BERNARD MOSES ISIKOFACILITY TYPE:
735
ADDRESS:13142 CROWLEY STREETTELEPHONE:
(818) 394-9745
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 6CENSUS: 4DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator, Bernard IsikoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an annual required visit of the facility. At 11:00AM Patience Iwikirde, Joy Ouma and Hanns Arinda all DSP (Direct Support Professional) met LPA at the entrance and LPA explained the reason for the visit. Administrator Bernard Isiko, was contacted and arrived thereafter. The facility retains clients placed by NLACRC-North Los Angeles County Regional Center. The facility is a level 3.

Resident and Staff Records reviews and interviews: From 11:30AM four 3:30PM four (4) out four (4) client records and six (6) out of seven (7) staff records were reviewed to ensure compliance.
LPA reviewed a total of six (6) staff members including the Administrator's file for the criminal background clearance, CPR/First Aid training, and all required and current training and association to the facility.
LPA reviewed four (4) client files that are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights observed.
LPA reviewed the record of one (1) client safeguarded cash/P&I and amount was verified.
LPA reviewed medications for one client, C4 to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed.
Interview of one (1) staff was conducted. Interview of one (1) client was conducted.

At 1:10PM LPA with the assistance of the administrator took a tour of the facility and the following was observed.

-Continue to LIC 809-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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: ROYAL TRINITY ENRICHMENT CENTER
FACILITY NUMBER: 197608636
VISIT DATE: 08/05/2024
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Common Area: LPA observed the living room and furniture to be clean and in good repair. The facility maintains a comfortable temperature at 76 degrees Fahrenheit. Smoke and carbon monoxide detectors are hardwired they were tested and deemed operational. One (1) Fire Extinguisher observed in the kitchen with inspection date of 4/11/2024. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed by the entrance.

Kitchen: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator, and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Knives were stored in a locked cabinet in the kitchen. Food preparation areas are clean. Garbage can had tight fitting cover. Clients' dining table fits enough for six (6) people. Kitchen cleaning supplies were also locked and stored underneath the kitchen sink.


Bedrooms: There are four (4) client bedrooms. Clients' rooms were properly furnished with appropriate dresser, night stand, chair, bed with clean linens. Each room had sufficient lighting. Client's room were clean and in good condition. Extra towels and linens/beddings are stored in the hallway closet accessible to clients.
Bathrooms: There are two (2) bathrooms designated for client use. The bathrooms were properly supplied and had functional fixtures and non-slip bath mats. The hallway bathroom hot water temperature was measured at 107.4 degrees
Surrounding Grounds: There is a covered patio furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have any bodies of water.
Garage: LPA observed the garage is an attached garage accessible from the house. Garage is used for storage and laundry area. Extra food supplies, a functional refrigerator, additional toiletries, PPE supplies and cleaning solutions were observed in the garage. The washer and dryer is located inside the garage. Laundry chemicals are stored in a locked upper cabinet in the garage. The garage remained locked and inaccessible to clients in care.
LPA observed a locked closet that contains all the clients' records, the staff records and the clients' medications. LPA observed the closet has a keyed entry door knob which remains locked at all times and inaccessible to clients in care. First-aid has all proper items and is current. LPA checked the Surety bond which has a renewal date of 1-24-2024. Fire drill was recently conducted on July 06, 2024.
The facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided to the administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC809 (FAS) - (06/04)
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