198603928-12-9-2025-28-AS-SMAN-DP84VS-20251209182651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603928
Report Date: 12/09/2025
Date Signed: 12/09/2025 06:27:04 PM

Document Has Been Signed on 12/09/2025 06:27 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	TWINSBOND GROUP INC		FACILITY NUMBER:	198603928
ADMINISTRATOR/ DIRECTOR:	ODUNOLA, TAIWO		FACILITY TYPE:	740
ADDRESS:	836 E 74TH STREET		TELEPHONE:	(424) 531-8065
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90001
CAPACITY: 6		CENSUS: 0	DATE:	12/09/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Director/Administrator Taiwo Odunola		TIME VISIT/ INSPECTION COMPLETED:	06:27 PM

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Licensing Program Analyst (LPA) Sakinah Madyun made an announced visit and met with Director/Administrator Taiwo Odunola to conduct a Pre-Licensing evaluation inspection.

An application was submitted to Community Care Licensing Department (CCLD) on 06/20/2025, for an initial application of a Residential Care Facility for the Elderly (RCFE) to serve adults ages 60 years old and over. The requested capacity is for a total of six (6) residents, of which four (4) ambulatory and two (2) non-ambulatory. Structure: Facility is a one-story home located in a residential area consisting of four (4) bedrooms, one and half (1 1/2) bathrooms, kitchen, dining room, living room, laundry area, staff area, and front yard shaded outdoor patio area. Client Bedrooms: Bedroom #4 (private) equipped with bed, night-stand, chair, lamp, and overhead lighting, bedroom #3 (shared) equipped with beds, night-stands, chairs, lamps, and overhead lighting, bedroom #2 (shared) with half bathroom included equipped with beds, night-stands, chairs, lamps, and overhead lighting, and bedroom #1 (private) with exiting door and wheelchair ramp equipped with bed, night-stand, chair, lamp, and overhead lighting. Bathrooms: One and half (1 1/2) bathrooms, one (1) full bathroom equipped with working toilet, sink, and bathtub and half (1/2) bathroom equipped with working toilet and sink. Linens & Hygiene Supplies: All beds had the required linen/supplies which include new mattresses, pillowcases, mattress pads, fitted sheets, blankets and bedspreads. Supply of extra bedding is stored inside bedroom closets, and hygiene products are stored in basket on top of the drawer dressers. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. One (1) fully charged fire extinguisher observed. Facility has a landline telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible in the cabinet near the stove. Adequate food supply is stored in the kitchen and consists of 7-day non-perishables. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator, oven, microwave, coffee maker, George Foreman grill and air fryer in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff.

***Narrative continues next page LIC 809C***

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TWINSBOND GROUP INC	FACILITY NUMBER: 198603928
	VISIT DATE: 12/09/2025

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Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits of 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the First-Aid kit has been inspected which has the following: manual, tweezers, scissors, ice packs/cooling patch, fever scans, bandages, sponges, pads, face masks, gloves, swabs, sterilization pads, pbt bandages, tapes, gauze, and outdoor CPR tools. Clients & Staff Files: Designated areas for files will be stored centrally in staff area of the facility inside locked file cabinet. Pools/Jacuzzi/Body of Water & Pets: No bodies of water located on the premises. Fire Clearance: Fire clearance was approved on 07/14/2025 for four (4) ambulatory residents, two (2) non-ambulatory residents, and zero (0) bedridden residents. Component III: Component III was unable to be reviewed at this time.

Observations:

Bedroom #4 (private)-

Replace 5 drawer dresser.

Replace 2 drawer dresser.

Window- is cracked on the right side that slides to open and needs to be replaced.

Vent- above the ceiling is hanging loose and needs to be affixed to the ceiling.

Ceiling Fan- missing a light bulb.

Floor- laminate under night stand and near bed needs to be replaced, lifting appears to be water damage.

Bedroom #3 (shared)-

5 drawer dresser set- top drawer is broken and needs to be repaired or replaced.

Replace 2 drawer dresser.

Window- is cracked, the window screen on right side is damaged with holes and needs to be replaced.

Replace both lamp shades.

Bedroom #2 (shared) with half bathroom included-

Sink Water temp- measured at 113.2 degrees Fahrenheit.

Replace 8 drawer dresser.

Replace lamp.

Ceiling Fan- Missing knob handles replace the string to an accessible length for residents. Missing a light bulb.

Floor- Upon entering the bedroom tile floor are damaged and loose and needs to be replaced.

Window- will not open or close and needs to be repaired.

Bedroom #1 (private) with exit door and wheelchair ramp-

Exit door with gate was dirty, full of spider webs, and needs cleaning.

Floor- Appears to be lifting with water damage to laminate flooring and needs to be replaced. Entrance/exit of bedroom door tile floor is damaged, loose, with a gap, and needs to be replaced.

Bathrooms- Residents full bathroom bathtub and toilet both need grout around the base. Shower head fixture attached to shower needs to be repaired. Replace tiles near the bathtub and toilet. Half shared bathroom is adequate.

Kitchen- Observed to be clear and free of debris with all appliances in good repair. Cabinets and storage cabinet included adequate dishes, utensils, cook ware, and 7 days of non-perishables.

Lower kitchen sink cabinet with pad lock missing knobs that need to be replaced.

Kitchen cabinet near stove missing knobs that need to be replaced.

Tiles on kitchen floor near the sink need to be removed and replaced.

Water temp- measured at 109.4 degrees Fahrenheit.

Fire and Emergency- Observed (1) fire extinguisher fully charged (last inspected 11-4-2025) located in the living/dining room/activity room area. There are four (4) sets of emergency kits available for six (6) of six (6) residents. Smoke and carbon monoxide detectors are located throughout the facility in good repair.

Items of correction:

1. Bedroom #4 (private)- Replace 5 drawer dresser. Replace 2 drawer and dresser. Window- is cracked on the right side that slides to open and needs to be replaced. Vent- above the ceiling is hanging loose and needs to be affixed to the ceiling. Ceiling Fan- missing a light bulb. Floor- laminate under night stand and near bed needs to be replaced, lifting appears to be water damage.

2. Bedroom #3 (shared)- 5 drawer set top drawer is broken and needs to be repaired or replaced. Replace 2 drawer dresser. Replace both lamp shades. Window- is cracked, the window screen on right side is damaged with holes and needs to be replaced.

3. Bedroom #2 (shared) with half bathroom included- Sink Water temp- is 113.2 degrees Fahrenheit. Replace 8 drawer dresser. Ceiling Fan- missing knob handles replace the string to an accessible length for residents. Missing a light bulb. Replace lamp. Floor- upon entering the bedroom tile floors are damaged and loose and needs to be replaced. Window will not open or close and needs to be repaired.

4. Bedroom #1 (private) with exit door and wheelchair ramp- Exit door with gate was dirty, full of spider webs, and needs cleaning. Floor- appears to be lifting with water damage to laminate flooring and needs to be replaced. Entrance/exit of bedroom door tile floor is damaged, loose, with a gap, and needs to be replaced.

5. Bathrooms- Residents full bathroom bathtub and toilet both need grout around the base. Replace tiles near the bathtub and toilet.

6. Kitchen- Lower kitchen sink cabinet with pad lock missing knobs that need to be replaced. Kitchen cabinet near stove missing knob that needs to be replaced. Tiles on kitchen floor near the sink need to be removed and replaced.

Licensee will contact LPA when corrections are completed to reschedule another inspection visit. An exit interview was conducted with Director/Administrator. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Sakinah Madyun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

LIC809 (FAS) - (06/04)

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