198601522-4-23-2024-28-AS-CWOG-D4LUKM-20240423153922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601522
Report Date: 04/23/2024
Date Signed: 04/23/2024 03:40:44 PM

Document Has Been Signed on 04/23/2024 03:40 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	LYDAY HOME		FACILITY NUMBER:	198601522
ADMINISTRATOR:	OLAIDE OSIBOGUN		FACILITY TYPE:	735
ADDRESS:	559 E. CYPRESS STREET		TELEPHONE:	(626) 498-0620
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	4	CENSUS: 3	DATE:	04/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	OLAIDE OSIBOGUN		TIME COMPLETED:	04:00 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 Analysts (LPAs) Christine Wong and Daniel Konishi conducted the required annual inspection. LPAs arrived unannounced and met with Staff Rafael Apolabi who allowed the entry of the facility and Shortly after, Administrator Olaide Osibogun arrived and assisted with the visit. The purpose for the visit was explained. The facility is licensed for age 18-59. Ambulatory only. The facility is a Level 4G Home vendeored with San Gabriel Pomona Regional Center. LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and here are the domains that LPAs inspected: 1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting each shift for high touched surface area. Facility has sufficient PPE supplies and has an Infection Control Plan in place. 2, Physician Plant and Environmental Safety: The facility is a single story house and it's located in a residential neighborhood area. The facility includes: living room, kitchen, laundry room, three clients' bedrooms, two clients bathrooms and a detached garage. Client's bedroom#1 and #2 have one bed, one chair, one night stand, required furniture and beddings and sufficient lighting and closet space. The bathroom is clean, sanitary and in a operational condition. The hot water temperature in client's bathrooms and kitchen were tested between 106.5 and 111.5 degrees F which is within Title 22 regulation. All the kitchen appliances are working well. All the sharp knives and utensils are stored and locked in the file cabinet next to the kitchen. The chemical and cleaning supplies are stored and locked in the hallway cabinet. The extra personal hygiene are stored in the hallway cabinet. The facility telephone service is on the premises. The hallway night usually on during night time and clients can have the access to the non-private bathroom. LPA inspected the carbon monoxide detectors and they are working well.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LYDAY HOME	FACILITY NUMBER: 198601522
	VISIT DATE: 04/23/2024

NARRATIVE

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3. Operational Requirement: The facility is approved for ambulatory clients only and currently all three clients in the facility are ambulatory. The client would be able to attend the community events if there's an opportunity or chance. The facility has a shaded patio area with chair and table for client to utilize the outdoor activity. The last fire drill was conducted on 4/15/2024.

4. Staffing: Facility has sufficient staffing in the facility. LPA inspected the NOC shift staff file and the staff has the required facility planned emergency procedure training.

5. Personnel Record-Training: All the staff files are stored in the garage/office. LPA inspected all four (4) staff files and they are all over 18 years old, fingerprinted cleared and associated with the facility. All the staff files have the required documents which included: health screening and TB test result, updated first aid certificate and required training hours. The facility administrator is Olaide Osibogun and her administrator certificate expire on 4/16/2025 and she has the required TB and HIV training certificate in file.

6. Client's Right-Information: No client is required any postural support in the facility. The facility served client with at least one internet access device and equipped with video conferencing for client to meet with their day program or medical appointment if needed.

7. Food Service: The facility has sufficient 2 days perishable and 7 days non-perishable food supply in the facility. All the food are stored properly in the facility. Currently there's no client required any modified diet.

8. Client's record-Incident Report: All the clients files are stored in the garage/office. LPA inspected all 3 client's files and they all have the required documents which include: admission agreement, face sheet, ambulatory status, Individual Program Plan (IPP) medication list and physician report.

9. Health Related services: All the clients medication are centrally stored and locked in the file cabinet near the kitchen /dining table. LPA inspected all three (3) clients medication and they all seemed accurate and updated. All 3 clients have the 30 days supply of medication. The facility also assisted client with doctor and dental appointment with transportation too.

10. Incidental Medical Services: There's no client in the facility is on any restricted or prohibited health condition plan at the present time.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LYDAY HOME	FACILITY NUMBER: 198601522
	VISIT DATE: 04/23/2024

NARRATIVE

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11. Disaster Preparedness: The facility has an updated emergency disaster plan and the facility conducted fire/disaster drill monthly. The facility has two temporary alternative shelter location.
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12. Emergency Intervention: The facility does not use any restraint on clients but all the staff are CPI trained.

No deficiencies were observed during the annual inspection

Exit Interview conducted and a copy of the report was provided to the administrator Olaide Osibogun.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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