191202138-12-11-2024-31-AS-LDLC-DBV6GP-20241211194817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202138
Report Date: 12/11/2024
Date Signed: 12/11/2024 07:48:56 PM

Document Has Been Signed on 12/11/2024 07:48 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 SOL		FACILITY NUMBER:	191202138
ADMINISTRATOR/ DIRECTOR:	NANCY BISSONETTE-ANDREW		FACILITY TYPE:	775
ADDRESS:	9919 SUNLAND BOULEVARD		TELEPHONE:	(818) 352-1419
CITY:	SUNLAND	STATE: CA	ZIP CODE:	91040
CAPACITY: 304		CENSUS: 190	DATE:	12/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Teresa Rathsam, Senior Regional Director		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

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Licensing Program Analysts (LPA) Leizl de la Cerra conducted an unannounced Annual/Required 1 year visit to this facility. LPA met with Teresa Rathsam - Senior Regional Director, and stated the purpose of the visit.

LPA conducted a tour of the facility with Ms. Rathsam inside and outside to ensure there are no health and safety hazards and is compliance with Title 22 Regulations.

A tour of the physical plant was conducted including staff offices, surrounding grounds and homerooms.

Dining area - During the tour of this area, LPA observed several tables and chairs for clients use. The area also has cabinet spaces for clients to store personal belongings.

Food preparation/Kitchen - LPA observed the kitchen area to be clean and sanitary. Refrigerators and pantry were observed to have sufficient food for clients in care.

Surrounding Grounds: This Day Program has a picnic/BBQ areas, a track, gardens, stables, barnyard/farm and various parking areas. LPA observed that there was adequate furniture located throughout the grounds that was appropriate for outdoor use. There was shaded areas for clients use. There were ramps available for non-ambulatory clients.

Swimming pool - There is a pool, which is heated, and used 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 a lifeguard on duty when the pool is being used.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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: 12/11/2024

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Homerooms: Homerooms are used for music therapy, healthy lifestyles education and for arts and crafts. The rooms appear to be clean and organized.

Restrooms - LPA observed several restrooms at the facility that were 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 they are as follows: 106-117 degrees F.

Fire extinguishers were checked and were found fully charged. Fire and earthquake drill are conducted . Last fire drill was done on 8/23/24. Last earthquake drill 10/17/24. LPA also observed the facility's first aid kit and it has sufficient supplies for clients' needs.

Administrative: LPA collected a copy of Certificate of Liability Insurance effective until 07/01/25

Staff Personnel Files: A review of facility staff files was conducted. LPA reviewed 6 staff files to ensure compliance.

Due to time constraints LPA was unable to complete the Required 1 year visit. Teresa Rathsam was informed that a follow up visit will be made to complete the required annual visit.
Exit interview conducted and copy of this report was delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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