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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700936
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:39:25 PM

Document Has Been Signed on 02/21/2023 04:39 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 HOME IIFACILITY NUMBER:
342700936
ADMINISTRATOR:OFODIRE, PEARLFACILITY TYPE:
735
ADDRESS:9400 FEICKERT DRIVETELEPHONE:
(916) 230-0690
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:22 PM
MET WITH:Pearl OfodireTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual inspection. LPA met with Administrator Pearl Ofodire, and explained the purpose of the visit.

LPA completed the infection control tool. LPA and facility staff toured the facility to ensure compliance with Title 22 regulations. LPA was later met by Administrator Pearl Ofodire. LPA observed the resident bedrooms. The bedrooms were observed to have necessary furniture and furnishings. The rooms were organized and free from debris. The bathrooms were observed to be clean and free from debris. The hot water measured at 118.3*F, which is within the regulatory range. Common areas were also observed to be organized and clean. The facility is equipped with an emergency supply of food and water, a supply of perishable foods for seven days, and a supply of non-perishable food for a minimum of two days. Fire extinguishers were observed to be in working condition and up to date. Medications, sharps, and cleaning supplies were observed to be locked away and inaccessible to residents in care.

LPA requested the following documentation be sent to the Regional Office: LIC 500 Personnel Summary. All other forms were obtained prior to inspections.

No deficiencies were observed during today's visit. 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: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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