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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700936
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:40:21 PM

Document Has Been Signed on 03/06/2025 03:40 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 IIFACILITY NUMBER:
342700936
ADMINISTRATOR/
DIRECTOR:
OFODIRE, PEARLFACILITY TYPE:
735
ADDRESS:9400 FEICKERT DRIVETELEPHONE:
(916) 230-0690
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Pearl OfodireTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 3/6/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct their required annual inspection visit. LPA met with the facility administrator, Pearl Ofodire, and stated the purpose of this visit. Present during today's visit were 4 client in care with 2 staff on duty. Administrator Certificate expires on 10/9/2025.

LPA and Pearl inspected the physical plant including but not limited to the kitchen, dining room, 4 client bedrooms; 2 client bathrooms, laundry room, and outside/backyard. Facility is a one story home located in a residential neighborhood, with 4 bedrooms and 2 bathrooms. The facility serves adult clients with developmental/intellectual disabilities. Facility has a covered porch at the back area equipped with outdoor furniture. Fences and gate were observed to be in good repair at this time. Outside shed was observed to be locked and not accessible to clients in care. The garage was observed to be locked and not accessible to clients in care.

LPA observed room temperature at 72 degrees Fahrenheit. LPA observed sufficient furniture and lighting throughout the facility. LPA observed activity supplies for client use. LPA observed food supplies of at least 7-day non-perishable and 2-day perishable. Refrigerator and freezer temperatures were within regulatory range. Initial measurement of the hot water was above 120 degrees Fahrenheit (at 121 degrees Fahrenheit). After staff adjustment, the hot water measurement was 88 degrees Fahrenheit. Advisory was provided to Administrator to ensure to maintain hot water temperature between 105 and 120 degrees Fahrenheit. Advisory was provided to maintain a hot water temperature log; per Administrator, they will record hot water temperature on a monthly basis.



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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 II
FACILITY NUMBER: 342700936
VISIT DATE: 03/06/2025
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Fire extinguishers last inspected on 2/2/2025. Smoke detectors and carbon monoxide detectors were tested and found to be in good working condition. LPA observed centrally stored medications are kept locked and inaccessible to residents. First aid kit was checked and is complete. The facility conducts fire drills with residents on a monthly basis. Last fire drill was conducted on 2/18/25. Facility also conducts semi-annual disaster drill and last disaster drill was on 12/31/24.

LPA reviewed two (2) client files: Per review, 2 of 2 client have updated Needs and Services Plan and Medical Assessments. LPA reviewed P&I records and medication records of 2 clients in care and were found to be in compliance at this time.

LPA reviewed two (2) staff files: Per review, 2 of 2 staff have background fingerprint clearance and both are associated to the facility. 2 of 2 staff have current 1st Aid/CPR certificate. LPA verified staff training for staff file reviews.

LPA requested the following updated documents during this visit: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Liability Insurance Certificate, and Copy of Surety Bond.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no 4deficiencies cited during this visit.

Exit interview held with administrator. A copy of report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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