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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610134
Report Date: 05/31/2024
Date Signed: 05/31/2024 11:42:00 AM

Document Has Been Signed on 05/31/2024 11:42 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:REM CALIFORNIA LLC - DONNAFACILITY NUMBER:
197610134
ADMINISTRATOR/
DIRECTOR:		TURYASIIMWA, ASSUMPTAHFACILITY TYPE:
735
ADDRESS:9512 DONNA AVETELEPHONE:
(818) 998-3161
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 4DATE:
05/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Gboyega Akinbola, Abinbola AdeyemiTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff Abinbola Adeyemi, and advised her of the Annual. The administrator Gboyega Akinbola joined the Annual shortly after.

At approximately 9:30am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a level 4, one story building, that serves clients age 18-59. Required postings were posted at the front. The smoke alarms and sprinkles were observed and interconnected . There is a functional carbon monoxide detector installed in the hallway, outside of the staff office. There are fire extinguishers located in the hallway and kitchen. The charge date is 12/01/2023. The last fire and earthquake drills were conducted on May 16, 2024

Kitchen: The kitchen was observed to have functional appliances and fixtures. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were observed locked in a kitchen drawer.

Bedrooms: There are four (4) bedrooms which are all private. LPA observed each client room to be properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: The facility has has two and one half (2 1/2) bathrooms. The two (2) bathrooms are for client use. The half bathroom, located in the laundry area, is reserved for staff. Water temperature in the bathrooms measured between 105-109 degrees F. Bathrooms designated for clients were properly supplied and had functional fixtures. No cleaning supplies were observed in the bathrooms during inspection.

Common Areas: These included the living room and dining area. The living room is furnished with couches and recliners. The dining room has a table large enough to seat six (6). Furniture was observed to be in good repair. Floors were mopped and clean. Hallways, entry and exits were clear of any obstruction.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REM CALIFORNIA LLC - DONNA
FACILITY NUMBER: 197610134
VISIT DATE: 05/31/2024
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Surrounding Grounds: There is a center courtyard area in the back. Backyard space was large enough for outdoor activities. There were some chairs observed outside, which was appropriate for outdoor use. The gates at both sides of the home were checked to insure no locks were installed, and that exits and passageways were clear for emergency evacuation. No immediate health and safety hazards present at the time of the visit.

Laundry area: The laundry area is located by bedroom #4 and the staff office. Cleaning supplies and detergents were locked in the cabinets.

Staff Workstation/Office: There is a staff office located at the hallway by the kitchen, where staff and client records are kept and locked in a filing cabinet.

Garage: The garage is attached to the building. The garage is used as storage for PPE, emergency kits, food and water. There is also a freezer for additional perishable food items, and a refrigerator for staff use. Entry to the garage from inside the home is located by the kitchen. No cleaning supplies or toxin stored in the garage at the time of the visit.

Medications: There is a medication cart in the staff office, that was locked during the inspection. Medications were reviewed for storage and documentation. Complete first aid kit also maintained inside the medication cart. One pharmacy is being utilized for prescription orders at this time. Refills are either done automatically every 30 days, or ordered by the physician. Medication records are maintained electronically.

Client/Staff Records: At approximately 10:30am, client and staff records were reviewed to insure compliance.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted. A Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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