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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603680
Report Date: 10/31/2024
Date Signed: 10/31/2024 10:12:09 AM

Document Has Been Signed on 10/31/2024 10:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AMAZING GRACE HOMES LLCFACILITY NUMBER:
198603680
ADMINISTRATOR/
DIRECTOR:		OYELEYE, TAIWOFACILITY TYPE:
735
ADDRESS:17639 1/2 VIRGINIA AVETELEPHONE:
(562) 841-2920
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 4CENSUS: 0DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Elizabeth FadahunsiTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Elizabeth Fadahunsi and explained the purpose for today’s visit. The facility is licensed to serve (4) Ambulatory Only Clients Ages 18-59 years. The facility currently has (0) clients.

The facility two-story's and located in Bellflower, Ca. A tour of the facility includes: 1st floor: living room, dining area, kitchen, 1 half bath, hygiene storage closet, laundry room, attached garage, front yard with outdoor activity area. 2nd floor: 3 bedrooms and 2 full bathrooms (1 bath is inside master room).

LPA utilized the Compliance and Regulatory Enforcement(CARE) tools for the visit & observed the following:


Infection Control: Facility maintains the required Infection Control Plan.Physical Plant & Environment Safety: LPA toured facility, clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. Passageways are free of obstruction. No bodies of water were observed at the facility. All storage areas for cleaning solutions, toxins, knives, and hazardous items have a designated locked area that is inaccessible to (locked kitchen cabinet). Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Food Service: The kitchen was observed for the ability to prepare and serve food. Operational Requirements & Staffing & Personnel Records-Training: There are currently no staff due to no clients, however, administrator is aware of the required training, fingerprint clearance staff must complete prior to working with clients. Administrator Taiwo Oyeleye is pending renewal, confirmed on the CCL website renewal was received by department 8/26/24, current administrator certificate expires 8/28/26. Client Rights-Information & Client Records-Incident Reports: Internet and Telephone are connected and readily available for client use. Client rights posters and reporting posters are displayed within the facility. There are no clients at the facility, however, there is a designated area where client files will be maintained within a locked cabinet in kitchen area. Disaster Preparedness: The facility has an Emergency Disaster Plan
Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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