198602385-8-19-2022-11-AS-PSCT-CHFRFJ-20220819125912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602385
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:59:21 PM

Document Has Been Signed on 08/19/2022 12:59 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	TRINITY HOMES II		FACILITY NUMBER:	198602385
ADMINISTRATOR:	AYOARIYO, GEORGE		FACILITY TYPE:	735
ADDRESS:	20331 CARON CIRCLE		TELEPHONE:	(310) 933-8447
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 4		CENSUS: 0	DATE:	08/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:29 AM
MET WITH:	Oluwarotim Johnson		TIME COMPLETED:	01:10 PM

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On 08/19/22, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with the house manager Oluwarotim Johnson. LPA explained the purpose of today’s visit. The facility is licensed to operate for four (4) ambulatory adults ages 18 through 59. Currently, this facility does not have any residents.

LPA Scott toured the facility along with House Manager Oluwarotim Johnson. The home consists of 4 resident bedrooms, 3 bathrooms, living room, kitchen, and dining area. There is a laundry area in the garage. All resident rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation and had adequate equipment for physically handicapped residents. Toilets and water faucets worked properly. Water temperature was measured at 109.3 for the kitchen and 106.6 for the bathroom.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were stored and not accessible to residents. The kitchen was inspected, and sufficient non-perishable food was maintained adequately. There weren’t any perishable foods because the facility does not have any residents currently. Fire extinguishers were charged, and smoke and carbon monoxide detectors were operable. The facility has a working landline telephone for residents.

Outside grounds were toured and no bodies of water were observed. Patio furniture was accessible with shaded area. Exits/ Walkways around the home were free of debris and hazards.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TRINITY HOMES II	FACILITY NUMBER: 198602385
	VISIT DATE: 08/19/2022

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During the visit, LPA observed the facility's infection control practices to be in compliance. LPA observed screening protocols for visitors. There is a sign in area for visitors with a temperature logbook. Sanitizing stations in common areas and restrooms. LPA observed house manager wearing face covering. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved CCLD Mitigation Plan. The facility has submitted an Infection Control Plan to the regional office.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Oluwarotim Johnson.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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