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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601120
Report Date: 05/02/2022
Date Signed: 05/02/2022 10:52:41 AM


Document Has Been Signed on 05/02/2022 10:52 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:PHIL & GRACE HOMES INC.FACILITY NUMBER:
385601120
ADMINISTRATOR:BIGGENS, OMOZELEFACILITY TYPE:
735
ADDRESS:1658 YOSEMITE AVETELEPHONE:
(415) 279-0344
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:6CENSUS: DATE:
05/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Omozele BiggensTIME COMPLETED:
11:00 AM
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On May 2, 2022, Licensing Program Analyst (LPA) Komal Charitra and Jaime Vado conducted an announced Pre-Licensing inspection visit. LPAs met with Administrators Omozele Biggens, Osabuihien Omogbai, and Osa N Aigbuza. Omozele Biggins will be the primary Administrator. Upon arrival, LPAs observed COVID-19 signage posted at front entrance. This is an all ambulatory, 6 bed home.

LPA observed facility to be two stories. No accessible bodies of water or fire safety hazards observed, LPA observed the centralized communal living room area. Medication closet was observed to be locked. LPAs observed 2 bedrooms, 1 full bath on the second floor, and 1 bedroom and 1 full bathroom on the ground floor. LPAs inspected both facility bathrooms and both are in good condition. Faucets operate appropriately. Water temperature in the bathrooms and kitchen was measured at 115F-120F. Bedroom #2 was observed to have a fire safety exit leading to the backyard which is alarmed.

All 3 bedrooms will be shared rooms. All bedrooms contained the required furniture and lighting requirements per CCLD regulations. Administrator to install emergency lights in rooms and hallway. Smoke detectors are hard wired through out facility. Carbon monoxide detector is in place. Both bathrooms were equipped with liquid soap, paper towels, covered trash bins, and hand washing signage. 30-day PPE supply present and LIC808 COVID Mitigation to be approved by CCLD.

Backyard contains a storage shed which will only be used for a storage area. Backyard is clear, free from any hazards and fencing is in place. No firearms on the premises. Laundry room is observed as in order and fully functional. LTCO posting needs to be posted.

Component 3 was reviewed with the Administrators. Files were reviewed and in place.

Report was reviewed with Administrators and a copy is provided.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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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