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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601522
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:44:54 PM

Document Has Been Signed on 05/04/2023 03:44 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LYDAY HOMEFACILITY NUMBER:
198601522
ADMINISTRATOR:OLAIDE OSIBOGUNFACILITY TYPE:
735
ADDRESS:559 E. CYPRESS STREETTELEPHONE:
(626) 498-0620
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 4CENSUS: 4DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Olaide Osibogun TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Administrator Olaide Osibogun who allowed the entry of the facility and assisted with the visit. The purpose for the visit was explained. The facility is licensed for age 18-59. Ambulatory only.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and here are the domains that LPA inspected:

1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting each shift for high touched surface area. Facility has sufficient PPE supplies and has an Infection Control Plan.
2. Physical Plant and Environmental: The facility is a single story house and located around the residential neighborhood area. The facility includes: living room, dining area, kitchen, laundry area, three clients bedrooms and two clients bathrooms and a detached garage. LPA inspected the carbon monoxide detectors and its mounted on the hallway wall and its working well. LPA also inspected the smoke detectors and they are located each bedroom and common area and they are interconnected and working probably. LPA tested the hot water temperature in two clients bathrooms and they are tested between 113.3 and 117 degrees F which are within Title 22 regulation. All the sharp knives and utensils are locked in the file cabinet next to the kitchen. All the chemical and cleaning supplies are locked in the hallway cabinet which are inaccessible to clients. The facility has sufficient personal hygiene supplies for client to use. All clients rooms are furnished, clean and sanitize and have required beddings.
3. Operational Requirements: The facility maintained a fire clearance approved by the fire department which four ambulatory client and currently all clients in the facility are ambulatory. The facility also has shaded area with table and chairs for client to utilize for outdoor activity. The last fire/disaster drill were conducted on 3/10/23
(See LIC 809C for continuation)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LYDAY HOME
FACILITY NUMBER: 198601522
VISIT DATE: 05/04/2023
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4. Staffing: The facility has sufficient staffing but the night supervision staff does not have any updated planned emergency training.
5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. The administrator (Olaide Osibogun) certificate expired on 4/16/23 but CCL received the administrator renew application on 2/23/23 and currently is pending. The administrator also has an updated HIV and TB Training. All the direct care staff has the updated first aid training and Medication Management Training.
6. Clients Right-Information: The facility does not have any client required postural support. The facility does serve adults has internet service shall provide at least one access device.
7. Client Records-Incident Reports: All the client files are maintained in the facility. All the files have the required documents included: admission agreement, updated physician report , Individual Personal Plan (IPP) and functional capacity assessment..etc.
8. Food Service: The facility has two days perishable and seven days non-perishable food supply. The refrigerator is maintained in the required temperature. All the food are stored probably.
9. Health Related Services: All client medication are centrally stored and locked in the file cabinet next to the kitchen. All the client's medication are reviewed and they are all seemed accurate and updated.
10. Incidental Medical Services: The facility does not have any client who has the restricted health condition or prohibited health condition.
11. Disaster Preparedness: The facility has an updated emergency disaster plan but staff do not have annual training for emergency and disaster include staff responsibilities. The facility has an updated fire/disaster drill but did not indicate which type of drill and who participate in the drill.
12. Emergency Intervention: All staff have required training including the CPI and CPR training and they are all updated.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 1

Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the administrator Olaide Osibogun
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/04/2023 03:44 PM - It Cannot Be Edited


Created By: Christine Wong On 05/04/2023 at 02:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LYDAY HOME
FACILITY NUMBER: 198601522

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85065.6(b)(1)
Night Supervision
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency, and shall have received training in the following: (1) The facility's planned emergency procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed the night staff do not have the training for facility planned emergency procedures which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/18/2023
Plan of Correction
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Administrator will send the staff training log to LPA by POC due date
Type B
Section Cited
HSC
1565(b)
Other Provisions
(b) If a facility employs staff, the facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe any staff receive emergency disaster training annually which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/18/2023
Plan of Correction
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Administrator will send the training log to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023


LIC809 (FAS) - (06/04)
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