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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004686
Report Date: 09/08/2021
Date Signed: 09/08/2021 03:31:40 PM

Document Has Been Signed on 09/08/2021 03:31 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SOUTH COUNTY CARE IIIFACILITY NUMBER:
306004686
ADMINISTRATOR:SONIA DEZHAMFACILITY TYPE:
735
ADDRESS:22761 SWEETMEADOWTELEPHONE:
(949) 233-1416
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 6CENSUS: 4DATE:
09/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Sherry Taghdimi and Nazanine FarshidianTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Sherry Taghdimi and explained the reason for the visit. Administrator Nazanine Farshidian arrived during the visit.

At 1:10 PM, LPA toured the facility with Administrator Farshidian. Facility has 3 clients present during today's visit. All rooms are single occupancy. LPA observed clients relaxing in the facility. LPA spoke with clients present and all appeared happy and well taken care of. All client rooms had the required elements as well as restrooms stocked with soap/ sanitizer. LPA observed the sign in sheet in the entrance of the facility. Facility takes client temperatures daily. The facility mitigation plan has been completed and is pending approval. LPA observed adequate emergency food and water as well as the first aid kit. First aid kit contained all required items. LPA observed locked medication closet. Fire extinguisher is charged. Facility has a thirty day supply of PPE on-site. LPA toured the outside grounds and observed the outside shaded visitation area. Exit gate is unlocked and self latching. Clients enjoy community outings at least weekly. Facility has a plan for covid testing clients and staff as needed as well as a plan for isolation. All staff and clients are vaccinated for Covid-19. LPA reviewed four client files during the visit and all were up to date including updated client emergency information.

LPA consulted with Administrator on the importance of maintaining adequate covid precaution signage inside and outside the facility including hand washing signs in the restrooms.


No deficiencies noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2021
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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