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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603616
Report Date: 02/20/2024
Date Signed: 02/20/2024 02:30:57 PM

Document Has Been Signed on 02/20/2024 02:30 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:OLUWATOYIN HOME2, LLCFACILITY NUMBER:
198603616
ADMINISTRATOR:OSIBOGUN, OLAIDEFACILITY TYPE:
735
ADDRESS:155 W RENWICK RDTELEPHONE:
(626) 804-3418
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 4CENSUS: 4DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Olaide Osibigun- AdministratorTIME COMPLETED:
12:17 PM
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Licensing Program Analysts (LPA) Sanjay Vaid and Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPAs met DSP Doyin Olusanya and explained the reason for the visit. Administrator Olaide Osibogun arrived shortly thereafter. Physical Plant was toured, record of medications was reviewed, and food supply was inspected.
The following was observed/inspected:
LPAs and Administrator toured the home and inspected (4) client bedrooms, (2) bathrooms, living room, dining room, kitchen, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the back patio. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 and bathroom #2 and measured between 106.1F – 106.7F which is within the required 105F - 120F degrees. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen, and the linen is in good condition. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is a carbon monoxide detector located in the living room. There is a fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to clients. Cleaning supplies and disinfectants are locked in the garage and are inaccessible to clients. First Aid kit was fully stocked with current manual. Fire disaster drill was conducted on 02/11/2024 and earthquake disaster drill conducted on 02/09/2024.
Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed.
(4) out of the (4) client medications were reviewed. Medications are centrally stored in a locked cabinet located in the dining room. Medications are documented properly and given as prescribed.
Staff and Client files were reviewed during today's visit.
At the time of visit observed three clients at facility and one client was admitted to hospital.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. An exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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