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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603367
Report Date: 12/01/2021
Date Signed: 12/02/2021 09:41:04 AM

Document Has Been Signed on 12/02/2021 09:41 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EYANU HEALTH AND SERVICES LLCFACILITY NUMBER:
198603367
ADMINISTRATOR:OLATUNDE, KOFOWOROLAFACILITY TYPE:
735
ADDRESS:430 CHATTERTON AVENUETELEPHONE:
(626) 324-3134
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 3DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Kofoworola Olatunde TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with DSP Blessing Nnamani and explained the reason for the visit. Shortly after, the administrator Kofoworola Olatunde arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures and observed food supply. Facility has submitted a mitigation plan and was approved on 07/15/21

The facility is located at a residential neighborhood. The facility consists of four bedrooms and two bathrooms, living room, dining area, kitchen and a detached garage. Each bedroom has smoke detector, one bed, one drawer, night stand, required furniture and sufficient closet space and lighting. All two bathrooms were toured. Both bathrooms are clean and maintained in a good condition. The hot water temperature in both bathrooms were measured between 106.7 and 106.9 degrees F. The refrigerator in the kitchen, garage and kitchen cabinet has sufficient for 2 days perishable and 7 days non-perishable food. All the appliances are clean and working properly in the kitchen. The common areas such as living room and dining area are clean and have the required furniture. The front and back yard are maintained well. The back yard has a shaded area and sitting area. LPA inspected the smoke detectors and carbon monoxide detectors and they are working well. All the knives and sharp utensils are locked in the cabinet in the living room. The cleaning supplies are locked in the hallway cabinet which are inaccessible to clients. The medication are centrally stored and locked in the cabinet in the living room.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing and disinfected the facility each beginning of the shift. All the bathroom have sufficient soap, hand sanitizers, paper towels, and signs. The PPE supplies are sufficient for 30 days.

No deficiencies were found during this visit. Exit interview was conducted with administrator Kofoworola Olatunde. A copy of the report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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