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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601716
Report Date: 05/09/2023
Date Signed: 05/09/2023 03:48:02 PM

Document Has Been Signed on 05/09/2023 03:48 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CHOICES R US - MIGUELFACILITY NUMBER:
198601716
ADMINISTRATOR:CARDENAS, GILBERTFACILITY TYPE:
735
ADDRESS:3951 MIGUEL AVETELEPHONE:
(562) 801-3061
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 3DATE:
05/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator Adeshola ObayoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an annual inspection using the Inspection tool. On today’s visit LPA met with administrator Adeshola Obayo. The purpose of the visit was discussed.

As a part of the inspection, LPA used the inspection tool, reviewed (3) client records, (3) staff files, and (3) client medications. Currently the facility has (3) clients of which (3) are ambulatory. The facility is vendorized through Eastern Los Angeles Regional Center. Facility is a one story family home with three (3) bedrooms. Bedroom #1 and #2 are for one (1) client. Bedroom #3 is for up to (2) clients. There is (1) bathroom for client use. There is also a living room, a kitchen, central air and heating, a dining area, a shaded area located in the backyard. A detached car garage inaccessible to clients. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. All bedrooms equipped with required furniture for up to (4) clients. Bathroom #1 has a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms and Carbon monoxide detectors operational. Required postings observed. Water temperature within required tittle 22 regulations.

Inspection tool was completed , no deficiencies are being cited on this visit. An exit interview was conducted and a copy of this report was provided to Administrator Adeshola Obayo
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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