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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609704
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:21:05 PM

Document Has Been Signed on 08/17/2022 04:21 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:SAFE LAUREL LLCFACILITY NUMBER:
197609704
ADMINISTRATOR:GBOYEGA AKINBOLAFACILITY TYPE:
735
ADDRESS:16300 VINTAGE STTELEPHONE:
(818) 489-1218
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 0DATE:
08/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Gboyega AkinbolaTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Abeye Duguma met with the administrator, Gboyega Akinbola, for a One (1) Year Required - Infection Control visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 3:00pm and the following was noted:
There is one entrance being utilized at the facility, there are required posters at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff was observed to be wearing masks upon entrance and during the visit. Hand washing, coughing etiquette, physical distancing and other necessary signs are posted in the bathroom and throughout the facility. The facility has enough PPE supplies. The facility has a total of four (04) bedrooms and three (03) bathrooms. The facility is fire cleared for four (04) ambulatory. The facility is currently occupying zero (00) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. Living and dining room furniture were also checked. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 78°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. The bedrooms are adequately furnished with appropriate lighting system. Hallways are well lit. The bathrooms were checked for cleanliness and proper operations. The hot water temperature was measured at 115.7°F. There was enough clean linen available in the cabinets. LPA observed medication cabinet with locking mechanism and complete first aid kit.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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