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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603506
Report Date: 08/29/2023
Date Signed: 08/29/2023 05:19:38 PM


Document Has Been Signed on 08/29/2023 05:19 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:REM CALIFORNIA, LLC - PENNSYLVANIAFACILITY NUMBER:
198603506
ADMINISTRATOR:SALAU, ADEMOLAFACILITY TYPE:
735
ADDRESS:11343 PENNSYLVANIA AVETELEPHONE:
(562) 529-2524
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:4CENSUS: 3DATE:
08/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Adedamola Oladeji, DSPTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced case management visit to the facility. The purpose of today’s visit was to serve the Order to Licensee of Immediate Exclusion from Facility for staff (S1). An investigation by the California Department of Social Services was conducted and it was determined that staff (S1) violated California Code of Regulations Title 22 for personal rights.

On today's visit, LPA met with DSP Adedamola Oladeji and explained the reason for the visit. Administrator Ademola Salau was explained the purpose of the visit telephonically. DSP Adedamola Oladeji was provided with copies of the Order to Licensee of Immediate Exclusion and Order to Individual for Immediate Exclusion letters and Government Code 11522.

NOTE: El Segundo Regional Office Immediate Exclusion letters for facilities: REM California, LLC - Marcellus -198320234 and REM California, LLC - E. 213th - 198320232 were also issued to facility staff. Administrator Ademola Salau stated he will deliver the letters to the aforementioned facilities.

Exit interview was held with DSP Adedamola Oladeji. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023
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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