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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881186
Report Date: 04/13/2023
Date Signed: 04/13/2023 01:06:51 PM

Document Has Been Signed on 04/13/2023 01:06 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SOFIA CARE CENTERFACILITY NUMBER:
361881186
ADMINISTRATOR:ALLISON LAYGO ENRIQUEZFACILITY TYPE:
735
ADDRESS:19173 YANAN ROADTELEPHONE:
(909) 623-4964
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 6CENSUS: 0DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Rufina LaygoTIME COMPLETED:
01:10 PM
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Licensing Program Analysts (LPAs) Magda Malcore and Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection. LPAs arrived at the facility at 10:40 a.m. and waited for facility representatives to arrive to grand entry into the facility. LPAs met with Rufina Laygo, facility representative and discussed the purpose of the visit. At the time of the visit there were no clients and no staff at the facility.

The facility is an Adult Residential Facility (ARF) with 4 bedrooms, 3 bathrooms, kitchen/dining area, living room, and attached garage. LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPAs inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature.

LPAs inspected the kitchen. Sharps are stored and kept locked in kitchen drawers.

LPAs inspected bedrooms. Bedrooms are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting. Hallway cabinets are supplied with extra bedding linen.

LPAs inspected the bathrooms. Bathrooms were operating in a safe and sanitary conditions. The hot water temperature tested within regulation at 110 degrees F. Bathroom were equipped with slip mats.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SOFIA CARE CENTER
FACILITY NUMBER: 361881186
VISIT DATE: 04/13/2023
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LPAs observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguisher. Posters such as personal rights and the disaster plan were posted in a common area. Although there are no clients in care, cleaning supplies, toxins, items were kept locked in cabinets.

LPAs observed that the facility has a complete first aid kit and emergency supplies. Overall, the facility is clean, in good repair, and operating in safe conditions.

There were no clients or staff files to review at the time of the visit because the facility it not currently active; but LPA's were shown where staff and client files will be located

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, where this report (LIC809) was discussed and provided to Rufina Laygo.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
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