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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610136
Report Date: 02/04/2021
Date Signed: 07/12/2021 03:08:42 PM

Document Has Been Signed on 07/12/2021 03:08 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:REM CALIFORNIA, LLC - NORTH HILLSFACILITY NUMBER:
197610136
ADMINISTRATOR:OLATOYINBO, RIDWANFACILITY TYPE:
735
ADDRESS:16312 TUPPER STREETTELEPHONE:
(818) 830-5275
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 4DATE:
02/04/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Ridwan OlatoyinboTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Martina Berry conducted an announced Pre-Licensing visit due to change of ownership. Due to the situation surrounding Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this visit was conducted virtually via Microsoft Teams. The LPA met with Administrator Ridwan Olatoyinbo and explained the reason for the visit.

The LPA conducted a facility tour. This is a single story home that serves clients of North Los Angeles Regional Center. The facility has 4 bedrooms and 2 bathrooms. Each client has a private room. Bathrooms are shared amongst clients and staff. Each room is equipped with sufficient closet space and drawers for storage. Bathrooms are clean and in good repair with required grab bars and nonskid mats. Water temperature met Title 22 Regulations. Bathrooms have sufficient soap and paper towels. The facility has a sufficient supply of linen for client use.

Common areas provided sufficient seating for residents. Board games, cards, books, and puzzles are available for client use in the common areas. There is a fireplace with standing screen & tools were removed. The kitchen is clean; fixtures and appliances are in good repair. Toxic substances are kept in locked cabinets under sink and laundry area. Sharp knives are locked and inaccessible to clients. There is a sufficient supply of perishable & non-perishable foods. The kitchen is stocked with dishes, eating utensils, pots and pans.

Smoke detectors are hard wired throughout the facility. Fire extinguishers were serviced on 12/23/20 and were fully charged. Medication, client records and staff records, first aid kit are locked in a cabinet located in the kitchen. First aid kit has all required supplies.

The backyard has seating with shaded and unshaded areas. There is space for clients to engage in outdoor activities. The washer & dryer are in the attached garage that is used for storage of emergency supplies. This area is kept locked and inaccessible to the residents.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Martina Berry
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2021
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 - NORTH HILLS
FACILITY NUMBER: 197610136
VISIT DATE: 02/04/2021
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The LPA observed that all areas in the facility met Title 22 Regulations. The Component III Orientation was completed on 2/4/21. No additional items are needed prior to license approval. An exit interview was conducted with Administrator Ridwan Olatoyinbo. A copy of this report was provided via email for signature.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Martina Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021
LIC809 (FAS) - (06/04)
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