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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603367
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:58:48 AM

Document Has Been Signed on 11/14/2024 10:58 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/
DIRECTOR:		OLATUNDE, KOFOWOROLAFACILITY TYPE:
735
ADDRESS:430 CHATTERTON AVENUETELEPHONE:
(626) 324-3134
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 4DATE:
11/14/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Staff Dieumerci MvuambaTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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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 Dieumerci Mvuamba and the purpose of the visit was discussed. The following (CARE) tool domains were utilized during the inspection:

Infection Control:
  • Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. The facility has an Infection Control Plan for LPA to review.

Operational Requirements:
  • A current Plan of Operation was reviewed.
  • A fire clearance for four (4) ambulatory clients of which (0) may be non ambulatory;0 may be bedridden.

Staffing
  • Sufficient staff observed to meet clients needs
  • Facility currently provides care and supervision for a total of (4) Clients.


Personnel Records-Training:
  • Administrator on record to be updated. Administrator Certification is currently active
  • Staff have criminal background clearance and training.
  • Four (4) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR and CPI training was observed.

Continued on LIC 809-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 LLC
FACILITY NUMBER: 198603367
VISIT DATE: 11/14/2024
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Health Related Services:
  • Staff provided first aid assistance as well as assistance to medical and dentist appointments
  • Medications are provided to residents following prescription orders and instructions
  • LPA reviewed medications for all (4) Clients in care. No medication errors observed

Incidental Medical Services:
  • There are no clients with restricted health conditions
  • There are no clients with prohibited health conditions
  • No Restricted health conditions plans in place observed.

Disaster Preparedness:
  • Emergency and Disaster Plan LIC 610E is in place.

Emergency Intervention:
  • Staff is trained to use CPI techniques
  • No Manual Restraints are used.


All (12) domains have been completed as of todays visit. Per California Code of Regulations, Title 22, No deficiencies are being cited. Exit Interview Conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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