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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610464
Report Date: 12/10/2024
Date Signed: 12/10/2024 06:49:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/10/2024 06:49 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:UNIQUE GROUP HOMEFACILITY NUMBER:
197610464
ADMINISTRATOR/
DIRECTOR:		OMOTAYO, BABATUNDEFACILITY TYPE:
735
ADDRESS:8045 GROVE STTELEPHONE:
(818) 770-2940
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 4CENSUS: 0DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:OMOTAYO, BABATUNDE, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 12/10/2024 9:30AM Licensing Program Analysts (LPAs) de la Cerra and Leslie Ngo-Castaneda arrived at the facility listed above to conduct an unannounced annual inspection. There was no answer at the door after a few attempts, LPAs contacted the administrator by phone. LPAs were informed by the administrator that they were unavailable and will return to the facility at 2:00PM. LPAs returned to the facility at 2:30PM and administrator met LPAs at the door. LPAs explained to the administrator the reason for the visit.

This home is designed to operate as a Level 4 Adult Residential Facility (ARF), this facility's is cleared for four (4) ambulatory developmentally disabled clients.
At approximately 3:05PM LPAs and the administrator toured the facility, and the following was observed. The facility is a single-story building with an attached garage. The facility maintains a comfortable temperature at 70°F. LPA observed one (1) fire extinguishers, fully charged. LPAs observed the required facility postings by the entrance hallway. The facility provides a telephone for clients to use and LPAs observed the phone to be operational. LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Smoke detector was tested and was observed to function properly.

Kitchen Area: The main area kitchen where clients’ meals are prepared was observed to be clean. Appliances were clean and functional. LPAs observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food and were properly stored. LPAs observed knives kept in a locked cabinet, inaccessible to clients. Trash bin has a covered lid. The dining table by the kitchen area had the appropriate table and chairs to accommodate the clients at this facility.

Common Areas: The facility has a seating area available for client use. No obstructions and or tripping hazards throughout the common area.



SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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: UNIQUE GROUP HOME
FACILITY NUMBER: 197610464
VISIT DATE: 12/10/2024
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Bedrooms: There are four (4) bedrooms designated for client use. All bedrooms are furnished with a night stand, a chair, a lamp, a chest of drawers, a closet and a bed with clean bedding and linens. All bedrooms have sufficient closet space and have sufficient lighting.

Bathrooms: LPA observed two (2) bathrooms that are in good repair. LPAs observed the functional and appropriate fixtures. LPA observed the appropriate grab bars by the toilet and in the shower areas.
Garage/Laundry Area: LPAs observed the garage is detached from the facility. The garage is also used as a laundry area which has a functioning washer and dryer LPAs also observed a locked cabinet that stores laundry detergents and some cleaning solutions.

Surrounding grounds: No bodies of water was observed. LPAs observed the backyard free from obstructions. A seating area with shade was available for clients to use.

Facility Records: At 3:15PM LPAs conducted a review of the administrator's file.
Currently there are no clients at this facility, therefore LPAs did not conduct a review of any client files.

No deficiencies cited during today's visit. Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
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