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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002843
Report Date: 01/28/2022
Date Signed: 01/28/2022 10:22:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:QUEEN OF HEARTS EL DORADO HILLSFACILITY NUMBER:
095002843
ADMINISTRATOR:SOTO-ALFARO, CINDYFACILITY TYPE:
740
ADDRESS:3352 MESA VERDES DRTELEPHONE:
(916) 417-2456
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: DATE:
01/28/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Margie SohaniTIME COMPLETED:
10:30 AM
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On January 28, 2022, at 9am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived to conduct a Post Licensing. LPA met with Margie, the Licensee, and informed her of the reason for the visit. Prior to the inspection, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19, contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a Mask was worn for Personal Protective Equipment (PPE). Additionally, LPA was screened by staff upon arrival.

Margie and LPA toured the facility's.

LPA observed the following:
Administrator certificate is valid expiring 11/4/2022. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. Facility temperature measured 73 degrees F.

Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6

Exit interview conducted and a copy of this report given to Margie.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
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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