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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700065
Report Date: 08/18/2023
Date Signed: 08/18/2023 12:40:24 PM

Document Has Been Signed on 08/18/2023 12:40 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:WILTON STABLESFACILITY NUMBER:
342700065
ADMINISTRATOR:TANYA BARRETOFACILITY TYPE:
735
ADDRESS:11119 MANN ROADTELEPHONE:
(916) 687-4548
CITY:WILTONSTATE: CAZIP CODE:
95693
CAPACITY: 4CENSUS: 4DATE:
08/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH: Kolu SokodoloTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson arrived to the facility unannounced to conduct a 10-Day Visit. LPA contacted Administrator Tanya, which stated she is no longer the administrator and provided contact information for appointed administrator Kolu Sokodolo. Administrator Kolu Sokodolo started with Wilton Stables on 08/17/2023. LPA and LPM met with designated person.

Upon arrival, LPA and LPM noticed the facility van. The van's passenger side mirror was broken and hanging downwards with duct tape surrounding the mirror. A picture reference was taken for later review.

LPA and LPM toured the facility to ensure compliance with Title 22 regulations. LPA observed Kolu's Administrator Certificate to be active with an expiration date of 12/23/23 There are currently 4 residents; however, they were all at day programs, work, or an outing. Resident bedrooms were observed to be clean and free from debris. Resident bathrooms were clean and fully stocked. Emergency exits were clear from obstructions in all areas of the home including the garage. The medication cabinet was observed to be unlocked, which poses a potential health and safety risk to residents in care. LPA observed Administrator showing LPA how the medication cabinet locks. Although the Administrator locked the cabinet, some drawers were not locked and the drawers were able to be pulled outward.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 6, deficiencies are being cited on LIC 809 - D. Appeal Rights were provided. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
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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Document Has Been Signed on 08/18/2023 12:40 PM - It Cannot Be Edited


Created By: Christina Valerio On 08/18/2023 at 12:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: WILTON STABLES
FACILITY NUMBER: 342700065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2023
Section Cited
CCR
80074(c)

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80074 Transportation (c) Motor vehicles used to transport clients shall be maintained in a safe operating condition. This requirement was not met as evidenced by:
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Licensee stated they will put in a ticket for the car to be repaired. LPA to receive a picture copy once the mirror has been fixed. LPA to receive POC by POC due date.
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Based on observations, the licensee did not ensure that the facility vehicle was in safe operating condition. This poses a potential health and safety risk to residents in care.
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Type B
09/15/2023
Section Cited
CCR80075(k)(1)

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80075 Health Related Services (k) The following requirements shall apply..:
(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement was not met as evidenced by:
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Licensee stated they will ensure staff are trained on 80075(k)(1) and will ensure staff double check to see if cabinet is locked. Licensee to send an in-service sign in sheet for all staf by POC due date. Licensee stated they will purchase a new medication cabinet by POC due date.
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Based on observation, the licensee did not ensure the medication cabinet was locked. This poses a potential health and safety risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Christina Valerio
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023


LIC809 (FAS) - (06/04)
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