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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602573
Report Date: 08/19/2022
Date Signed: 08/19/2022 11:06:59 AM

Document Has Been Signed on 08/19/2022 11:06 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:TRINITY HOMESFACILITY NUMBER:
198602573
ADMINISTRATOR:AYOARIYO, GEORGEFACILITY TYPE:
735
ADDRESS:17505 HARWICK CTTELEPHONE:
(310) 753-3777
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 4CENSUS: 0DATE:
08/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Oluwarotim JohnsonTIME COMPLETED:
11:20 AM
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On 08/19/22, Licensing Program Analyst (LPA) Perry Scott made and unannounced inspection to Trinity Homes. The purpose of today’s visit was to conduct the Required Annual inspection, with an emphasis on infection control. During today’s visit, LPA met with house manager Oluwarotim Johnson and explained the reason for the visit. The facility has a capacity of 4 clients. The facility currently has no clients. When the facility is operational, all clients are between the ages of 18-59.

LPA Scott toured the facility along with Oluwarotim Johnson. The home consists of 4 client bedrooms, 2 bathrooms, living room, kitchen, dining area, office and laundry area which is in the garage. The facility has a sign in area for visitors, temperatures are taken and logged into the visitor log book. All client 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 regulations, and both had adequate equipment for physically handicapped clients. Toilets and water faucets worked properly. Showers were free of mold/mildew and equipped with grab bars and non-skid mats. There was adequate lighting and sufficient toiletries accessible to clients. Water temperature measured at 119.3 degrees in the kitchen and bathroom. The facility has two working land-line telephones one in the kitchen and the other in the living room area.

Since the facility doesn't have any clients at present, it is stocked with non-perishable foods. Supply was checked and adequately stocked at time of visit. Carbon monoxide detector was operational. Smoke detectors were working properly, fire extinguisher was fully charged and operational, toxins and sharps were locked and inaccessible to clients and were kept in the garage. There is a cabinet for medications when clients are available that has a lock and is inaccessible to clients. The facility has a thirty (30) supply of PPE.

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)
Page: 1 of 2
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
FACILITY NUMBER: 198602573
VISIT DATE: 08/19/2022
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The first aid kit was checked and in order, including manual. 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.

During the visit, LPA observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD

LPA observed no deficiencies that needed to be corrected.



Exit Interview Conducted and a copy of report was given 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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