198601522-5-3-2022-28-AS-CWOG-CE3PDP-20220503111353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601522
Report Date: 05/03/2022
Date Signed: 05/03/2022 12:04:11 PM

Document Has Been Signed on 05/03/2022 12:04 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	LYDAY HOME		FACILITY NUMBER:	198601522
ADMINISTRATOR:	OLAIDE OSIBOGUN		FACILITY TYPE:	735
ADDRESS:	559 E. CYPRESS STREET		TELEPHONE:	(626) 498-0620
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	4	CENSUS: 4	DATE:	05/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	OLAIDE OSIBOGUN		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with Caregiver Eugene Omoruan and explained the reason for the visit. Shortly after, the lead staff Rapheal Afolebi and administrator Olaide Osibogun arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed clients files. Facility has submitted a mitigation plan and was approved on 7/7/21. The facility is vendorized with San Gabriel Pomona Regional Center and its licensed with the AGE RANGE 18 THROUGH 59. AMBULATORY ONLY. The facility is a single story house and consists of: living room, dining area, kitchen, three clients bedrooms and two bathrooms, laundry area and a detached garage. All clients' rooms were toured. Client Bedroom#1 has two beds, two chairs, one drawer, required furniture and linen and sufficient lighting and closet space. Client Bedroom#2 has one bed, one chair, one drawer, required furniture and linen and sufficient lighting and closet space. Client Bedroom#3 has one bed, one chair, one drawer, required furniture and linen, and sufficient lighting and closet space. The clients bathrooms are clean, sanitary and operational. The hot water temperature in both clients bathrooms are measured between 114.4 and 114.9 degrees F which is within the Title 22 regulation. The food supply in the kitchen is sufficient for two days perishable and seven days non perishable. All the appliances in the kitchen are working properly. The sharp knives are locked in a cabinet near the kitchen. All the toxic and cleaning supplies are locked in the hallway cabinet which are inaccessible to clients. The front and back yard are maintained well. The back yard has shaded area with tables and chairs which is available for client to use. The back yard is free of debris. The exit and passage ways are free of obstruction. LPA also inspected the smoke detectors and carbon monoxide detectors are interconnected and they are operational.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LYDAY HOME	FACILITY NUMBER: 198601522
	VISIT DATE: 05/03/2022

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LPA reviewed all four client files to confirm emergency contact is updated. LPA also reviewed all four clients' medications and they are centrally stored and locked in the cabinet near the kitchen and the clients' medications are seemed accurate and updated and the record is current.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in each room and facility is disinfected every shift, the clients' bathrooms have sufficient soap, paper towels, and signs, and PPE supplies are sufficient for 30 days.

No deficiencies were observed during today's inspection.

Exit Interview conducted. A copy of the report was provided to administrator Olaide Osibogun

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

LIC809 (FAS) - (06/04)

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