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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700807
Report Date: 01/06/2022
Date Signed: 01/06/2022 12:14:51 PM

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:AGAPE SUPPORTED HOMESFACILITY NUMBER:
342700807
ADMINISTRATOR:OMORAGBON, OSCARFACILITY TYPE:
735
ADDRESS:3120 MOUNTAIN VIEW DRIVETELEPHONE:
(916) 993-8433
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:4CENSUS: 3DATE:
01/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Janet EgberuareTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Avelina Martinez and Maja Jensen arrived at this facility unannounced on 01/06/2022 at 11:33 AM to conduct a case management visit. LPA met with Janet Egberuare and explained the purpose of the visit.

The purpose of the visit today, is in response to staff and management work schedules that were submitted to Community Care Licensing Department (CCLD). Upon arrival Hilary Inneh was not present at the facility due to other urgent matters. Oscar Omoragbon was not present in the facility. Oscar is currently attending a 4 week training seminar at Alta Regional Center. Facility staff provided a weekly schedule for care staff, and Hilary Inneh emailed LPA Martinez a management staff work schedule. Moreover, during the visit, LPA Martinez spoke with Hilary Inneh via phone call. LPA Martinez reviewed facility staff/management schedules and informed Hilary Inneh of TSP services. Hilary Inneh reported he is interested in receiving TSP services. LPA Martinez will follow up on TSP services with Oscar Omoragbon.

As a result, of this visit, no deficiencies were cited per Title 22 Regulations. An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
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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