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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603819
Report Date: 02/06/2025
Date Signed: 02/06/2025 01:56:02 PM

Document Has Been Signed on 02/06/2025 01:56 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:KOKUMAH EVERYDAY GRACE TWO INCORPORATIONFACILITY NUMBER:
198603819
ADMINISTRATOR/
DIRECTOR:		ODOFIN,OLUWAGBEMIROFACILITY TYPE:
735
ADDRESS:115 EAST GLADSTONE STREETTELEPHONE:
(818) 448-3012
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 4CENSUS: 0DATE:
02/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:03 PM
MET WITH:Applicant Akunwale Orunesajo TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a pre-licensing visit. LPA met with applicants Akinwale Orunesajo and Olumagbemi Odofin. An initial application was submitted to Community Care Licensing Department (CCLD) for an Adult Residential Facility (ARF) to serve 6 ambulatory only clients ages 18 through 59. Fire clearance approved for four (4) ambulatory only. Bedrooms one (1) and three (3) approved for one (1) ambulatory each. Bedroom two (2) approved for two (2) ambulatory. This property has never been licensed. The physical plant was toured with the applicant. Comp III waived existing Licensee.

The facility is in a residential area and is a one-story family home. There are three (3) client bedrooms, one (1) office, three (3) bathrooms, living room, dining room, kitchen, laundry area, front yard, back yard and attached garage. LPA conducted the tour and observed the following: Smoke detectors/carbon monoxide detectors were observed in common areas and in each client’s bedroom. Client’s bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient closet space. The required bedding was also observed. LPA observed extra linen and towels in hallway closet. The home has three (3) bathrooms and are clean and sanitary. The water temperate was tested and measured within the required 105-120 degrees. There is a fire extinguisher in living room. All appliances in kitchen were observed to be clean and operational. Cleaning supplies chemicals and sharps and knives are stored in a locked cabinet in hallway. Medications are locked in a file cabinet in dining area. All files will be kept in office closet. The garage will be used as storage area for clients. The backyard has a shaded area with patio furniture. The home does not have a pool or any large bodies of water. No records were reviewed since the home has never been licensed. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements.

Exit interview held and a copy of the report was provided to applicant.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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