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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880820
Report Date: 02/24/2023
Date Signed: 02/24/2023 10:26:58 AM

Document Has Been Signed on 02/24/2023 10:26 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:YEMMA CARE HOME INCORPORATIONFACILITY NUMBER:
331880820
ADMINISTRATOR:OYEBOBOLA, OLAYEMIFACILITY TYPE:
735
ADDRESS:24507 POINSETTIA DRIVETELEPHONE:
(818) 213-8485
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY: 4CENSUS: 4DATE:
02/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Emmanuel Oyebobola- House ManagerTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced case management visit during complaint visit, control number 56-AS-20230221105402. LPA met with House Manager Emmanuel Oyebobola and explained the reason for the visit. Upon entry to the facility, there were three (3) staff present.

During today visit, LPA spoke to Staff S1 who was mopping the floors in the hallway and the living room area. LPA was informed that S1 has been working at the facility for one (1) month without a criminal record clearance. This poses an immediate health, safety, or personal rights risk to persons in care.

Based on observations today, one (1) type A deficiency was cited per Title 22, Division 6, of the California Code of Regulations, along with a $500-dollar civil penalty.



An exit interview was conducted, and this report (LIC809) was discussed and provided to House Manager Emmanuel Oyebobola, along with a copy of LIC809D, LIC421BG, and the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/24/2023 10:26 AM - It Cannot Be Edited


Created By: Ryan Gardner On 02/24/2023 at 09:32 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: YEMMA CARE HOME INCORPORATION
FACILITY NUMBER: 331880820

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/25/2023
Section Cited
CCR
87355(e)(1)

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87355. Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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The licensee has agreed to read regulation 87355 entirely and send LPA self-certified letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 2/25/2023.
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Based on observation, interview and record review, the licensee did not comply with the section cited above evidenced by allowing S1 to work at the facility for one (1) month without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Efren Malagon
LICENSING EVALUATOR NAME:Ryan Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023


LIC809 (FAS) - (06/04)
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