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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604861
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:05:34 AM

Document Has Been Signed on 11/07/2024 11:05 AM - 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CASA SOPHIAFACILITY NUMBER:
374604861
ADMINISTRATOR/
DIRECTOR:		WIDMAN, VANESSAFACILITY TYPE:
735
ADDRESS:1144 E CHASE AVENUETELEPHONE:
(619) 631-7656
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 4CENSUS: 3DATE:
11/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:56 AM
MET WITH:Hannah Haverly, Licensee
Vanessa Widman, Licensee		TIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Renita Hall conducted an announced pre-licensing visit. LPA was allowed entry by Hannah Haverly, Licensee, and  Vanessa Widman, Licensee.  LPA identified herself and disclosed the purpose of the visit.

This report documents the pre-licensing Component III visit conducted to determine the applicant's readiness to operate an Adult Residential Facility (ARF) in compliance with Title 22 regulations and the facility’s established operational plan.

The Component III process is designed to confirm the applicant’s understanding of the operational and regulatory requirements for an ARF. During the interview, the Licensing Program Analyst (LPA) discussed and reviewed key areas related to facility operations, client care, and regulatory compliance. The applicant’s qualifications, experience, and certifications were reviewed to ensure compliance with the minimum standards outlined in Title 22. The applicant has demonstrated adequate qualifications and holds the necessary certification as per Title 22 requirements.

The applicant’s understanding of policies for admission, retention, and discharge of residents was discussed, including emergency procedures, staff training, and reporting requirements. The applicant has developed clear procedures for client admission and discharge in line with Title 22.

Continued on 809C
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CASA SOPHIA
FACILITY NUMBER: 374604861
VISIT DATE: 11/07/2024
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Reviewed client rights, including the right to privacy, dignity, and freedom from abuse. Also discussed were personal services such as assistance with daily activities and ensuring residents’ individual needs are met. The facility layout, safety features, and accessibility were reviewed to verify compliance with fire safety, sanitation, and accessibility requirements. Emphasized the importance of maintaining accurate records for residents, facility operations, and staff, as well as reporting incidents and changes to licensing as required.

Based on the Component III review the facility is ready to be licensed as an Adult Residential Facility. The applicant does meet the criteria outlined in Title 22 and has demonstrated adequate preparedness to ensure resident safety, well-being, and compliance with regulatory standards. An exit interview was conducted with the Licensee's, to whom a copy of this report, and the Applicant/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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