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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005946
Report Date:
03/23/2022
Date Signed:
03/23/2022 04:05:51 PM
Document Has Been Signed on
03/23/2022 04:05 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:
SERRA SOL
FACILITY NUMBER:
306005946
ADMINISTRATOR:
LOPEZ, JANELLE
FACILITY TYPE:
740
ADDRESS:
31451 AVENIDA LOS CERRITOS
TELEPHONE:
(916) 836-8022
CITY:
SAN JUAN CAPISTRANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
70
CENSUS:
25
DATE:
03/23/2022
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
02:29 PM
MET WITH:
Susie Peterson
TIME COMPLETED:
04:22 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the post licensing inspection (mitigation). LPA was greeted and granted entry to the facility. LPA met with Administrator Susie Peterson. LPA explained the reason for the visit. LPA and Administrator toured the facility. LPA observed the resident rooms inspected had the required furnishings. Hot water temperature measured between 107.4 degrees Fahrenheit and 113.4 degrees Fahrenheit. During the visit a resident pulled the fire alarm switch. The fire alarms sounded and lit up signaling an emergency. Staff saw that a resident had set off the alarm and deactivated the alarm and redirected the resident. There was no emergency. LPA and Administrator toured the kitchen. The kitchen was clean and organized. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed emergency food and water stored in the kitchen. The dining room is spacious and will accommodate all of the residents. The medication room is kept locked and all of the medication is kept secured. There is an interior courtyard that has shaded seating areas for the residents to sit outside. LPA observed hand sanitizing stations throughout the facility. All fire extinguishers are fully charged. The last fire drill was conducted on 2/28/22. Facility has a mitigation plan that is pending approval. No obstacles or hazards observed during the visit. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
03/23/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/23/2022
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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