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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602214
Report Date: 04/25/2024
Date Signed: 04/25/2024 10:48:22 AM

Document Has Been Signed on 04/25/2024 10:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE 7FACILITY NUMBER:
198602214
ADMINISTRATOR/
DIRECTOR:
EBENEZER AKINOLAFACILITY TYPE:
735
ADDRESS:772 COBRE CTTELEPHONE:
(909) 629-1715
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 5CENSUS: 3DATE:
04/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:03 AM
MET WITH:ADESOLA ODETUNDE STAFFTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with Staff, Adesola Odejunde.The purpose of the visit was explained.

The facility cares for adults with developmental disabilities The facility is licensed for (5) ambulatory clients, ages 18 – 59. The one-story home has 4 bedrooms, 2 bathrooms, laundry room, living room with open kitchen, and an attached garage.

LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. The facility does not have a swimming pool or bodies of water on the premises. The smoke detectors are interconnected and operable. The carbon monoxide detector was also tested and operable. Knives, cleaning solutions, and disinfectants are locked inside a cabinet located in the garage. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. There are sufficient food supplies of 2-day perishable and a week of non-perishable items. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 45 degrees F. Both are kept clean, and food are properly stored.

Four (4) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Three (3) client files were reviewed and included physicians report, TB clearance, and individual program plan (IPP)report. Last fire/earthquake drill was conducted in December 2023. Infectious control plan was reviewed. The medications are centrally stored and locked in a cabinet by the kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all 3 clients, and they are being administered as prescribed by the physician. No deficiencies were observed during this visit per Title 22.

Exit interview was conducted with Adesola Odetunde and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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