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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610204
Report Date: 11/09/2022
Date Signed: 11/09/2022 10:17:26 AM

Document Has Been Signed on 11/09/2022 10:17 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:STRATHERN STREET DIVINE HOMEFACILITY NUMBER:
197610204
ADMINISTRATOR:ADEFEMIWA, TOLUWALOPEFACILITY TYPE:
735
ADDRESS:19952 STRATHERN STREETTELEPHONE:
(818) 274-1809
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Toluwalope AdefmiwaTIME COMPLETED:
10:30 AM
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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Toluwalope Adefmiwa and explained the reason for the visit. At this time, the facility doesn't have any clients as they are awaiting for their vendor license from Regional Center.

At approximately 9:00am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. There is a carbon monoxide detector, installed in the hallway that functions properly. The fire extinguisher is located in the kitchen. It is fully charged.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of non-perishable food ready for when clients start moving in. The administrator will purchase fresh perishable items once the first client gets admitted. No sharps or knives observed. Sharp and hazardous objects will be kept locked in the garage. The medication will be stored locked in one of the kitchen cabinets.

Bedrooms: There are four (4) bedrooms designated for residents' use. All four bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. At this time, since facility is vacant, Bedroom 1 is being used to store PPE supplies. Administrator was advised to remove them, once utilized by residents.

Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit.

Common Areas: These included the living room and dining area. The common areas were properly furnished. The smoke alarms were tested and functional at the time of the visit.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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: STRATHERN STREET DIVINE HOME
FACILITY NUMBER: 197610204
VISIT DATE: 11/09/2022
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
Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The laundry area is located in the garage. Hazardous, sharps and detergents are stored there, where it will kept locked and inaccessible to the clients. .

Resident Files: Facility has no clients, therefore no files to review.

Staff Files: Although the licensee continues to retain there license, facility is not operating at this time. No staff files to review.

Medications: Will be maintained in the kitchen. No files to review at this time.

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

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2