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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202138
Report Date: 10/31/2023
Date Signed: 10/31/2023 02:08:43 PM

Document Has Been Signed on 10/31/2023 02:08 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TIERRA DEL SOLFACILITY NUMBER:
191202138
ADMINISTRATOR:NANCY BISSONETTE-ANDREWFACILITY TYPE:
775
ADDRESS:9919 SUNLAND BOULEVARDTELEPHONE:
(818) 352-1419
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 304CENSUS: 304DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Case Manager Julie Synder/ Sandy Lara DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Christopher Alemoh and Michael Cava conducted an unannounced Annual/Required visit to this facility. LPAs met with Julie Snider Case Manager and Sandy Laras Director and informed her of the purpose of the visit. A copy of the Liability Insurance was reviewed

LPA Alemoh conducted a tour of the facility with Snider/Lara inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. Common areas were observed for the safely and the ability to serve the needs of clients, including cleanliness. LPAs checked physical plant, client records, and staff records. LPA Alemoh observed the storage areas for toxins, sharps, and other hazardous items to be locked and secured.

Dining/Kitchen Area - During the tour of this area, LPA's observed several tables and chairs for clients use. Dining area also has a flat screen for associate entertainment. Meals are prepared on site for clients with no dietary restrictions. Clients with the dietary restriction bring their own food. Snacks are served in dining area. At the time of visit 25 residents were using the kitchen and dining area. Kitchen has 2 refrigerators, and two freezers food items are categorized and dated. Sharp objects are stored in pantry located at the back of the kitchen. The door remains locked and is inaccessible to clients.

Fire extinguishers were checked and were found fully charged and serviced on Oct 2023. Fire and earthquake drill are conducted every month. The Great Shake was a facility wide earthquake drill was done on 10/19/23. Last fire drill was conducted on June 26th, 2023.

Restrooms - LPA observed several all-gender restrooms at the facility to be sanitary. Some of the restrooms have signs posted with a handicap sign to assist clients with wheelchairs. The restrooms are also equipped with changing tables and cabinets that hold cleaning and changing supplies. Water temperature was measured and are as follows: 115 degrees in common bathroom areas throughout the hallways.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TIERRA DEL SOL
FACILITY NUMBER: 191202138
VISIT DATE: 10/31/2023
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Swimming pool - There is a pool, which is heated, and used all year round. The pool area has a locked fence about 7ft tall surrounding the pool area. The pool has an electric cover when not in use. There is first aid mounted on the wall centrally accessible. Attached pool house was recently remodeled. Pool area has one entrance. Clients are not allowed to enter pool area without supervision.

Vehicles- were checked and were observed to be sanitary, in good repair. Facility vehicles have a seven year warranty. Staff is required to do daily vehicle walk through. Vehicles receive basic maintenance monthly. service Vehicles are insured and registration is up-to-date.

Art, Music and Ceramics room were observed with clients participating. The rooms are furnished with tables and chairs and cabinets for storage of supplies.

Medication/Nurse- Program staff Leilani Dixon is trained to administer medications. Currently only two clients are required to take medication during program. These residents are Theresa Cotilla and Robbie. Staff receives medication monthly from parents and administers meds using small brown envelopes. A signature is required for each medication dispersed to client. Meds are kept in a locked closet only accessible by Nurse and RN.

Record Review, In addition to staff and client record review, facility records were also checked for insurance liability and vehicle maintenance.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC809 (FAS) - (06/04)
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