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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610561
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:24:15 PM

Document Has Been Signed on 06/19/2024 03:24 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EL-SHHADDAI'S ARF INC. 2FACILITY NUMBER:
197610561
ADMINISTRATOR/
DIRECTOR:		OYEBOBOLA, EMMANUELFACILITY TYPE:
735
ADDRESS:19640 PARTHENIA STREETTELEPHONE:
(818) 974-9264
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 0DATE:
06/19/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:EMMANUEL OYEBOBOLA- Administrator TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with facility Administrator Emmanuel Oyebobola and Assistant Administrator Adedeji Fagbola. An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on January 11, 2024. A fire clearance was approved on May 13, 2024, for a maximum capacity of two (2) Non-ambulatory and two (2) ambulatory adults.

A tour of the physical plant was initiated at 9:30 am and the following was observed:
KITCHEN: The facility has a Kitchen area equipped with a refrigerator, microwave oven, and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of four (4) clients.BEDROOMS: There are four (4) bedrooms designated for clients use. All four bedrooms are designated for private use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space. BATHROOMS: The facility has two (2) bathrooms. Bathroom 1 has access from bedroom #2. Bathroom #2 has access to bedroom #4. The hot water temperature was measured at 105.1 F. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining room, which were equipped with furniture, a television, a sofa, and a chair. There is a fireplace with a screen and a glass slide. It is non-operational. No fireplace tools or fixtures are present. The dining area has a dining table to accommodate four (4) clients. There were no visible immediate hazards. Temperature: Facility maintains a comfortable temperature of 67 degrees Fahrenheit. Laundry Area: The laundry room is located through the kitchen. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible in locked cabinets. MEDICATION: The medication will be kept in a locked cabinet in the entry area. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool that is fenced all around its parameters. The fence is at least five feet high with a gate, that is also five feet high.
(Continue 809 C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: EL-SHHADDAI'S ARF INC. 2
FACILITY NUMBER: 197610561
VISIT DATE: 06/19/2024
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 Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool that is fenced all around its parameters. The fence is at least five feet high with a gate, that is also five feet high. Gate was observed locked, making it inaccessible to clients to enter. LPA observed and inspected the detached ADU/Garage. Fire clearance is not consistent with the facility sketch, there's a license cannot be issued until this discrepancy is resolved. The Applicant has been instructed to contact Central Applications Bureau (CAB) for instructions.

Pre-Licensing is incomplete. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
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