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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610235
Report Date: 04/18/2022
Date Signed: 04/18/2022 02:30:42 PM

Document Has Been Signed on 04/18/2022 02:30 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:WYSE HOMEFACILITY NUMBER:
197610235
ADMINISTRATOR:LABEODAN, TAYOFACILITY TYPE:
737
ADDRESS:35158 WYSE ROADTELEPHONE:
(626) 500-1430
CITY:SANTA CLARITASTATE: CAZIP CODE:
91390
CAPACITY: 4CENSUS: DATE:
04/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tayo Labeodan, AdministratorTIME COMPLETED:
02:35 PM
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At 10:35 am Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an announced pre-licensing visit with licensee Tayo Labeodan and Project Manager Matthew Riddell. The facility currently has a capacity of four (4) clients. While touring the facility LPA observed the COVID-19 signs posted outside near the front entrance.

There are four (4) private resident bedrooms. The rooms observed with necessary furniture and lighting. All rooms checked appeared clean and well organized. An emergency exit plan/sketch is posted on the hallway wall. There are three (3) bathrooms in the facility. One (1) bathroom is designated for staff use only and the common bathrooms have appropriate grab bars installed.

The laundry area is located next to bathroom on right side of hallway.
LPA observed an unstocked linen closet at the end of hallway.

The kitchen is clean and appliances in the kitchen appeared to be functional. Kitchen has a refrigerator, microwave, double oven, and dishwasher. The kitchen area has sufficient supply of cups, bowls, plates, utensils, pots, and pans.
The living room is clean but requires adequate sofas, loveseats, and coffee tables.

The home has a carbon monoxide detector and all smoke detectors was checked for operation. The smoke detectors are hard wired throughout the facility. The hot water temperature checked to be at 135 degrees, which is above required range.
(continued on LIC 809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2022
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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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: WYSE HOME
FACILITY NUMBER: 197610235
VISIT DATE: 04/18/2022
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(Cont. from 809)

The bedrooms are furnished with beds and other required furniture including nightstand, individual lamps, chair, and dresser. LPA observed closets in each bedroom.
Dining room area has a large dining table and 6 chairs.
There is a gazebo with seating as well as a patio table set with chairs with sufficient seating for the clients. There is also a small basketball court for client’s recreational use. The backyard is fenced. The garage is attached to the house with access from the inside. The garage is currently being used as the office and staff check-in area. There is no body of water at the facility.

At time of visit this facility is not ready to be licensed. The following corrections must be made:

· Water temperature adjusted from 135 degrees to 105-120 degrees.

· Provide First Aid Kit

· Locked area to store client medications

· Locked area to store sharps

· Locked area to store cleaning supplies

· Locked area to store client and staff records

· Provide bathroom skid mats, curtains, paper towels, hand washing signage

· Provide adequate seating in the living room area

· Provide items for recreational activities (books/games and etc)

· Add sufficient quantity of linens and towels

Exit interview conducted and a copy of report was provided to the Administrator

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
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