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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603658
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:52:47 PM

Document Has Been Signed on 07/02/2024 04:52 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:DIGNITY HOME CENTER INCFACILITY NUMBER:
198603658
ADMINISTRATOR/
DIRECTOR:
DUROMOLA, ADEBOWALE EVELYNFACILITY TYPE:
735
ADDRESS:230 E BENWOOD STTELEPHONE:
(626) 922-3944
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 6DATE:
07/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Adebowale Evelyn Duromola, administratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Adebowale Evelyn Duromola, administrator, who assisted with the visit. Facility is licensed to serve six (6) to serve clients for age range from 18 years old through 59 years old. Facility receives case management services provided by San Gabriel Pomona Regional Center.

For this annual visit, CARE tool was used, a physical plant was conducted, food supply/medication were reviewed, staff / clients were interviewed, and staff/clients’ records were reviewed. The facility annual fees are current. Administrator certificate is current with expiration date on 12/27/24.

The facility is a single-family residence located in a neighborhood, consist of four (4) client bedrooms, two (2) bathrooms, living room, kitchen with dining area, office, and laundry area in the attached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Clients’ rooms are furnished with appropriate furniture and in compliance. The bathrooms are furnished with grab bars and nonskid surfaces. Hot water temperature measured in a range of 113.5 to 114.9 degrees Fahrenheit. Facility maintained a comfortable temperature for clients. Sufficient supplies of perishable and nonperishable foods are observed. Toxic substances, knives, tools, sharp items are inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers are fully charged. Medication, clients’/ staff’s records are centrally stored in a locked cabinet and inaccessible to clients.

No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed and provided to Administrator, Evelyn.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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