<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603367
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:46:52 PM

Document Has Been Signed on 11/07/2024 03:46 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:EYANU HEALTH AND SERVICES LLCFACILITY NUMBER:
198603367
ADMINISTRATOR/
DIRECTOR:
OLATUNDE, KOFOWOROLAFACILITY TYPE:
735
ADDRESS:430 CHATTERTON AVENUETELEPHONE:
(626) 324-3134
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 4DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Staff Oluwabunmi AjiteruTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Staff Oluwabunmi Ajiteru and the purpose of the visit was discussed. The following (CARE) tool domains were utilized during the inspection:

Physical Plant/Environment Safety:
  • The facility is located in a residential area. It is a single-story home and includes: Living room, kitchen, 4 bedrooms, 2 bathrooms, dining area, backyard and an attached garage/laundry area.
  • The physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies, sharps and toxic substances are inaccessible to clients.
  • Fire Alarms/CO2 detectors were inspected. Fire extinguishers Observed
  • Water temperature readings measured within the required 105 - 120 degrees Fahrenheit.
Client Records-Incident Reports:
  • A total of Four (4) client files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment / IPPs, Physician's Orders, medical consent, and medication records.
Client Rights-Information
  • Client P&I Funds observed and safely stored
  • Internet source provided to clients in care
  • Complaint poster and Personal rights were observed posted.
Food Service:
  • Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies observed.
  • Sanitation practices and kitchen cleanliness was observed.


Due to time constraints, LPA Villalobos to return at a later date to complete the inspection. No deficiencies are being cited for this visit. Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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 1