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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701253
Report Date: 06/06/2023
Date Signed: 06/06/2023 12:35:57 PM

Document Has Been Signed on 06/06/2023 12:35 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:IKENNA CARE HOMEFACILITY NUMBER:
342701253
ADMINISTRATOR:OFODIRE, UZODINMAFACILITY TYPE:
735
ADDRESS:9866 FALCON MEADOW DR.TELEPHONE:
(713) 516-4867
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Uzodima Ofodire AdministratorTIME COMPLETED:
01:00 PM
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On June 6th at 9:35am LPA's Jennifer Fain and Maja Jensen arrived at the facility announced to conduct a pre licensing visit. LPAs met with Licensee Uzodinma Ofodire and explained the reason for the visit.

LPAs Fain and Jensen toured the grounds and physical plant. The grounds were observed to be clear of debris and all paths were unobstructed. LPA Fain observed patio furniture with shaded areas for residents to enjoy outdoor activities. The physical plant has 4 resident bedrooms. The interior of the facility was observed to be sanitary, adequately furnished and adequately lit. The facility maintains an adequate supply of linens and hygiene products. The bedrooms contained a night stand, lamp, dresser and chair. The mattresses were observed to have mattress covers. The facility has a locked storage area for medications, toxins and knives. All appliances appeared to be in good working order. The first aid kit is complete with scissors, tweezers, thermometer, manual and various wound dressings. The Emergency Disaster plan was reviewed and determined to be in compliance. The fire extinguishers were serviced January 31, 2023 and are in compliance. The carbon monoxide detectors and smoke detectors were determined to be in good working order. The Pre-Licensing Inspection Tool was utilized during the course of this visit.

The facility was determined to be in substantial compliance with the Health and Safety Code and the California Code of Regulations. The facility has passed the pre-licensing inspection. Component III was conducted.

An exit interview was conducted and a copy of this report was provided to Licensee
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Jennifer Fain
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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