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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603369
Report Date: 09/07/2022
Date Signed: 09/07/2022 02:28:57 PM

Document Has Been Signed on 09/07/2022 02:28 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: 4DATE:
09/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jennifer OguduTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with DSP Jennifer Ogudu and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed clients and staff files. Shortly after, the administrator ADEDOLAPO OLUSOJI arrived and assisted with the visit.

The facility is a single story house and located in a residential neighborhood area. The facility includes kitchen, laundry room, dining area, living room, four clients bedrooms, two bathrooms, storage room, staff office and detached garage. All 4 clients' bedrooms were toured. Each client bedroom has one bed, drawer, night stand, required bed linen and furniture and sufficient lighting and closet space. All 2 bathrooms were toured and they were clean, sanitary and in a operable condition. The hot water temperature in both bathrooms was tested between 107 and 108 degrees F. which is within the Title 22 regulation. The refrigerator in the kitchen and garage has sufficient two days perishable and seven days non-perishable food supply. All the kitchen appliances are clean and working properly. 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 and the back yard has a shaded area with table and chairs for clients to utilize. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all working well.

During the visit, LPA reviewed all 4 clients files to confirm emergency contact is updated. LPA also reviewed 3 staff files to confirm health screenings and fingerprint clearances and all 3 staff are fingerprint cleared and their health screenings forms are updated on the staff personnel file. LPA reviewed all 4 clients' medication and they are all seemed accurate and updated.

(See LIC 809C for continuation)
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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: DAZION INC
FACILITY NUMBER: 198603369
VISIT DATE: 09/07/2022
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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility.The disinfecting products are available in each bathroom and common area. Per staff, the facility was disinfected four times a week. The bathrooms have sufficient soap, paper towels, and signs and PPE supplies are sufficient for more than 30 days.

No deficiencies observed during the visit.

Exit interview conducted and a copy of the report was provided to administrator ADEDOLAPO OLUSOJI
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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