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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881266
Report Date: 03/08/2022
Date Signed: 03/08/2022 01:13:54 PM

Document Has Been Signed on 03/08/2022 01:13 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:EMMANUAL'S GROUP HOME ARF, INC.FACILITY NUMBER:
331881266
ADMINISTRATOR:OYEBOBOLA, EMMANUELFACILITY TYPE:
735
ADDRESS:6 VILLA SCENCEROTELEPHONE:
(818) 993-3666
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY: 4CENSUS: 0DATE:
03/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Emmanuel and Oiayemi Oyebobola, licensee/administratorTIME COMPLETED:
10:00 AM
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On 3/8/22 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced visit for the purpose of conducting a pre-licensing inspection. Upon arrival, LPA met with Emmanuel and Oiayemi Oyebobola, licensee. On 12/3/21 the Lake Elsinore Office of the Fire Marshall approved the facility for 4 ambulatory clients. The facility is a two story structure with 4 bedrooms (3 for clients and 1 for staff) and 3 bathrooms. There is a COVID-19 mitigation plan on file.

LPA toured the home inside and out. There is a COVID-19 screening station at the front entry. All client bedrooms are appropriately furnished according to regulations. The LPA observed the kitchen, dining room, living room and activity areas. The appliances in the kitchen operate properly. Sharps, cleaners and disinfectants will be kept locked and inaccessible to clients. The facility is stocked with dishes, glasses, and utensils all in good repair. There are no bodies or water on the property. The facility is stocked with a sufficient amount of personal hygiene supplies, and linens available for clients. The facility is stocked with a 2 day supply of perishable, and a 7 day supply of non-perishable food items. The emergency disaster plan, personal rights and complaint procedures are posted. The facility has a stocked first aid kit. The facility has a laundry room and laundry supplies that will be inaccessible to clients. The facility has a working land line telephone. The medication will be kept inaccessible to clients. Staff and clients files will also be inaccessible. The water temperature was within the regulated range. Fire extinguishers are located throughout the facility and are fully charged. There were no deficiencies observed during the inspection. Comp III was completed during the inspection. An exit interview was conducted where this report was provided to Emmanuel and Oiayemi Oyebobola.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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