342700433-1-4-2024-27-AS-AVIA-CZ6SMZ-20240104130047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700433
Report Date: 01/04/2024
Date Signed: 01/04/2024 01:00:53 PM

Document Has Been Signed on 01/04/2024 01:00 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	OFODIRE CARE HOME		FACILITY NUMBER:	342700433
ADMINISTRATOR:	OFODIRE, PEARL		FACILITY TYPE:	735
ADDRESS:	8952 PLAZA PARK DR		TELEPHONE:	(916) 230-0690
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY: 4		CENSUS: 4	DATE:	01/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Uzudinma Ofodire		TIME COMPLETED:	01:00 PM

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On 1/4/2024 at 10:08am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct an annual required visit. LPA initially met with staff on duty and explained the purpose of the visit. The designated manager, Uzudinma Ofodire, was informed of the visit and arrived to the facility shortly after. The facility is currently licensed to serve 4 developmentally disabled adults. Present during this visit were 1 client in care with 2 staff on duty.

At 10:25am, LPA and staff on duty inspected the facility’s physical plant including but not limited to the kitchen, dining room, client bedrooms, client bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a cliential neighborhood. There were no bodies of water on the premises. Outside of the facility was observed to be clean and clear of obstructions. Additionally, LPA observed outdoor furniture for clients’ use and covered area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 4 client bedrooms and 3 bathrooms for client use. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the client's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to clients in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 76 degrees F. Water temperature in one of the bathroom located in the hallway was measured at 118 degrees F. However, the bathroom located across the garage and next to the water heater was measuring at 125 degree F. LPA observed designated manager placed a signage indicating the the hot water temperature can reach to 125 degrees F. Fire extinguisher was serviced on 3/15/23 Smoke detectors and carbon monoxide were tested and found to be operable during this visit.

{Con't to LIC809-C}

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OFODIRE CARE HOME	FACILITY NUMBER: 342700433
	VISIT DATE: 01/04/2024

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{Con't from LIC809}

Medication storage area located in the kitchen was observed to be locked and inaccessible to clients in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each client Centrally Stored Medication, Destruction Record and PRN Log. All mandated infection control posters were posted. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for client use. LPA observed sufficient equipment and supplies to meet activity program needs of clients in care.

During this inspection, LPA conducted an audit of facility files, 4 client files, and 4 staff files for regulatory compliance. All staff noted on staff schedule have criminal background clearances and associated to this facility. LPA completed 2 staff interviews and attempted a client interview. 4 out of 4 client files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. 4 out of 4 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required trainings. Facility’s liability insurance is current per regulatory requirements. The facility is current on annual license fees. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of current liability insurance, current surety bond, LIC9282 and current staff schedule. Facility administrator submitted an updated LIC308 to LPA prior to this visit.

Per California Code of Regulations (Title 22, Division 6, Chapter 8), no deficiencies were observed during this visit. An exit interview was held with Uzudinma Ofodire, designated manager, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

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