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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610344
Report Date: 02/23/2024
Date Signed: 02/23/2024 01:38:05 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/23/2024 01:38 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMEN HOMESFACILITY NUMBER:
197610344
ADMINISTRATOR:AYOARIYO, GEORGEFACILITY TYPE:
735
ADDRESS:3611 TOPAZ LNTELEPHONE:
(310) 753-3777
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Babashola BabatundeTIME COMPLETED:
01:55 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) Lorena Casillas met with Back Up Administrator Babashola Babatunde for an unannounced one (1) year Required visit for this facility.

LPA arrived at 09:30 am and there was no one at the facility. LPA proceeded to call Licensee/Administrator and was told that staff would arrive shortly. The Back Up Administrator arrived at 12:20 pm. LPA informed the Back Up Administrator of the purpose of the visit.

Infection control: LPA Casillas reviewed Infection Control Plan submitted on 12/01/2022 to make sure licensee was following current infection control recommendations.

A tour of the physical plant was conducted with the Back Up Administrator at 12:30 pm. The facility has five (5) bedrooms and three (3) bathrooms currently unoccupied. Four (4) bedrooms are for resident use and one (1) bedroom will be used as an office. The facility is Fire Cleared for four (4) ambulatory.

The facility does not currently have residents, Inspection Tool Kit will not be used for this visit.

Food Inspection: LPA conducted a tour of the kitchen at 12:35 pm and observed there to be sufficient stock of seven-day non-perishables foods, there are no current residents therefore two day perishables have not been purchased. LPA advised Back Up Administrator that a stock of two day perishables need to be in the facility when residents are present. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects locked in a hallway closet. Medication will be stored in a locked cabinet located in a hallway closet and inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen. The fire extinguisher was observed full and last purchased on 12/05/2023. There is a fire blanket also located in the kitchen area. Continued on LIC809-C...
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMEN HOMES
FACILITY NUMBER: 197610344
VISIT DATE: 02/23/2024
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
Resident Rooms: LPA observed rooms to have the appropriate bedding. There is a nightstand, chair, and sufficient lighting for each resident.

Bathrooms: At 12:43 pm LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 12:59 pm and measured within regulation at 117.7 degrees F.

Laundry: At 12:44 pm, LPA observed chemicals/hazardous items locked in the laundry room and inaccessible to residents.

Physical environment: LPA toured the outside area of the facility at 12:50 pm. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises. LPA observed a locked empty shed in the backyard.

Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 73°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 1:15 pm.

Garage: At 12:58 pm, LPA observed the garage to be attached to the facility and currently being used to store extra water.

Administrative: Annual fee is current. Renewal of Administrator Certificate is on file and copy of Bond will be emailed to LPA.

An exit interview was conducted, and a copy of this report was given to the Back Up Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2