<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610170
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:45:29 PM

Document Has Been Signed on 09/15/2022 02:45 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:EL-SHADDAI'S ARF INCORPORATIONFACILITY NUMBER:
197610170
ADMINISTRATOR:OYEBOBOLA, EMMANUELFACILITY TYPE:
735
ADDRESS:18927 CHASE STREETTELEPHONE:
(818) 993-3666
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: DATE:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Deji FagbolaTIME COMPLETED:
02:55 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
Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced Annual Required infection Control visit to this facility at 12:50 pm. LPA Smith informed administrator the purpose of this visit and LPA temperature taken upon entry.

LPA conducted a tour of the physical plant at 1:00 pm to ensure there are no health and safety risks and facility staff are following Title 22 Regulations and the following was noted:



Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted all over the facility. All trash cans were observed to be with cover.

Facility has total of four (4) bedrooms: Three (3) for clients: two (2) private bedrooms and one (1) shared bedroom and one (1) for staff/isolation room. There are two (2) bathrooms: one (1) located in hallway and one (1) in bedroom #3. There is a pool on the property that was observed to be locked an inaccessible to clients.

Kitchen area was observed to be clean. LPA reviewed the food service area, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the four (4) clients currently residing there. Two (2) days of perishable fruits, vegetables, milk, and juice with excess water stored on floor in staff room. Sharps observed to be stored in locked boxed in bottom kitchen cabinet to the right of refrigerator observed to be inaccessible to clients.
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have supply of clean linen and towels in hallway cabinets. Closet near front door used to store staff files and closet in staff room used to store toiletries and PPEs.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: EL-SHADDAI'S ARF INCORPORATION
FACILITY NUMBER: 197610170
VISIT DATE: 09/15/2022
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
26
27
28
29
30
31
32
(Cont from 809)

Bathrooms were observed to be clean with necessary supplies. Hot water temperature for bathrooms: 115- and 118-degrees Fahrenheit.

Temperature of facility wall thermostat is observed and set to 75 degrees Fahrenheit.


Laundry room accessible through kitchen and backyard appliances observed to be in good repair.
Medications are located in dining room locked in metal four- drawer cabinet. Medication storage observed to be locked and inaccessible to clients. Stocked first aid kit attached to wall in kitchen/dining room. There is one (1) fire extinguisher located in kitchen/dining room near first aid kit observed to be charged. Smoke alarms and carbon monoxide detectors were present and function properly.
Garage: used to store excess PPEs and equipment

All the toxins, cleaning solutions and disinfectants are stored in three (3) cabinets in laundry room. Toxin cabinets observed to be locked and inaccessible to clients.

Backyard: There is a large patio table set with umbrella and chairs for clients use. All observed to be clean with adequate seating for the clients. The entry/exits area were clean and free of obstruction.

There were no immediate health and safety hazards observed during the day of inspection. There are no deficiencies to report.



Exit interview conducted and a copy of this report printed.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2