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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700433
Report Date: 01/17/2023
Date Signed: 01/17/2023 03:53:44 PM

Document Has Been Signed on 01/17/2023 03:53 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:OFODIRE CARE HOMEFACILITY NUMBER:
342700433
ADMINISTRATOR:OFODIRE, PEARLFACILITY TYPE:
735
ADDRESS:8952 PLAZA PARK DRTELEPHONE:
(916) 230-0690
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 3DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Pearl OfodireTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct the annual inspection. LPA met with Pearl Ofodire, and explained the purpose of the visit.

LPA and Administrator Pearl toured the facility to ensure compliance with Title 22 regulations. LPA observed 2 residents in the home with 3 staff. Staff were observed to be cleaning, preparing dinner, and assisting residents. Residents were observed playing with their electronic devices, watching television, and eating a snack. Hot water measured at 114.7* degrees F, which is within the regulatory range of 105*F - 120*F. The facility was observed to have an emergency disaster plan and equipped with emergency supplies (flashlights, blankets, food, water). The facility also has a ready to go suitcase in the event they need to leave right away.
First aid kit was observed to have necessary items. Medication cabinet was locked. Toxic supplies and sharps were locked away and inaccessible to residents in care. LPA interacted with staff and residents during the visit.

LPA requested the following documentation: LIC 500, Surety Bond, Resident Roster, Emergency Disaster plan, and LIC 308

Per California Code of Regulations (CCR), Title 22, no deficiencies were observed today. An exit interview was held with Administrator Pearl, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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