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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603369
Report Date: 09/21/2021
Date Signed: 09/21/2021 12:16:17 PM

Document Has Been Signed on 09/21/2021 12:16 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:DAZION INCFACILITY NUMBER:
198603369
ADMINISTRATOR:ADEDOLAPO OLUSOJIFACILITY TYPE:
735
ADDRESS:734 GLENEAGLES AVENUETELEPHONE:
(909) 233-4528
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 4CENSUS: 3DATE:
09/21/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Adedolapo Olusoji, administratorTIME COMPLETED:
01:30 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) Nicole Spencer conducted an unannounced Plan Of Correction (POC) visit following an annual inspection on 9/14/21 in which deficiencies were issued. The purpose of this visit was explained to the administrator Adedolapo Olusoji. During today's visit, LPA Spencer observed that the following Type A deficiencies were not corrected by POC due date of 9/15/21.

On 9/14/2021 the facility was cited for:

CCR 80088(e)(1) Hot Water Temperature- Administrator failed to comply with plan of correction due by 9/15/21 requiring water temperature be adjusted to temperatures of 105-120 degrees Fahrenheit. During annual inspection visit on 9/14/21, water temperature exceeded 120 degrees Fahrenheit. During today's visit, water temperature was below required 105 degrees Fahrenheit measuring 101.4, 99.8, and 100.5 degrees. Civil Penalties were issued for the period of 9/16/21 - 9/21/21 (6 days). The amount noted on Civil Penalty (LIC 421FC) is $600. A civil penalty of $100 per violation per day shall be assessed until deficiency is corrected.

CCR 80075(b)(5)(B) Medications- Administrator failed to complete plan of correction due by 9/15/21 in providing in-service medications training to staff. Per proof of corrections, staff were not provided medications training until 9/17/21. Civil Penalties were issued for period 9/16/21 - 9/17/21 (2 days). The amount noted on Civil Penalty (LIC 421FC) is $200. A civil penalty of $100 per violation per day shall be assessed until deficiency is corrected.

Civil penalties were assessed. An exit Interview was conducted with administrator and copy of the report and Appeal Rights were given.

SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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