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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881266
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:29:26 AM

Document Has Been Signed on 03/15/2023 11:29 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:EMMANUEL'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:
03/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Direct Support Person- Afeez BadmosTIME COMPLETED:
12:00 PM
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 Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit to conduct a Required Annual inspection. LPA spoke with Licensee Emmanuel Oyebobola on the phone and met with Direct Support Person (DSP) Afeez Badmos at the facility. This Adult Residential facility is licensed for four (4) ambulatory clients.
LPA observed that there are currently no clients admitted to the facility. Licensee stated the facility intends to continue to be licensed. LPA toured the facility inside and out. There are no pools, bodies of water, firearms or ammunition. LPA observed the facility is kept at a comfortable temperature. Hot water was measured in the kitchen sink at 111 degrees Fahrenheit. LPA observed non-skid mats or strips in showers and tubs. The client bedrooms have the required furniture and functional lighting.
LPA observed a sufficient supply of towels, linens and personal hygiene items. Cleaning supplies were observed to be locked in the garage. The facility’s smoke detectors and carbon monoxide detectors were tested and are in working condition.
LPA observed the kitchen to be clean and free of odor and all food is stored in a healthful manner. Appliances were observed to be operating. Frozen and refrigerated food is sealed correctly and protected against contamination. LPA observed an appropriate supply of 7-day non-perishable food in a pantry.
LPA observed where the client’s medications would be centrally located. Medication cabinet is observed to be secured and locked with a key. The facility plans to have an appropriate number of staff present in the during operating hours and during the evening/sleeping hours when admitting clients in care.
LPA reviewed facility files, signs, and required forms were seen posted. All files were organized and complete. The facility had a first aid kit and manual available. The patio area is shaded and has tables and chairs for client’s comfort. The back yard is completely enclosed and revealed no immediate hazards or obstructions.
No deficiencies issued per Title 22, Division 6 of the California Code of Regulations at this time.
An exit interview was conducted where this report was discussed and provided to DSP Afeez Badmos. LPA also provided DSP with LIC 9182 and asked to have the Licensee submit to CCLD.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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