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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700013
Report Date: 05/19/2022
Date Signed: 05/19/2022 12:03:22 PM


Document Has Been Signed on 05/19/2022 12:03 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ATASCADERO CHRISTIAN HOMEFACILITY NUMBER:
401700013
ADMINISTRATOR:CHRIS WOHLWENDFACILITY TYPE:
740
ADDRESS:8455 SANTA ROSA ROADTELEPHONE:
(805) 466-0281
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:64CENSUS: 17DATE:
05/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Chris Wohlend/AdministratorTIME COMPLETED:
12:45 PM
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At 10:30am on 05/19/2022, Licensing Program Analyst (LAP) Jeffries arrived at the facility, announced who he was and informed Administrator Chris Wohlend the reason for the visit was annual infection control inspection. LPA was screened at the front office entry point for COVID symptoms and was signed in as a visitor to the facility.

At 10:50am Administrator and LPA conducted the infection control module inspection. LPA advised Administrator to notify all residents who independently leave the facility to return to the single entry for return COVID screening. Administrator drafted a notice and had it sent out the the residents while LPA was still on infection control visit. LPA to note that this facility is in the process of closing and currently has a census of 17 residents with one resident in the hospital. Expected closure date is June 20th, 2022, only if all residents have been properly placed. LPA did not note any deficiencies during the infection control module.

Administrator and LPA conducted a physical plant walk through of the entire facility. LPA did not observe any obvious hazards or conditions that would put residents lives at risk. LPA observed several storage areas of PPE, in the office, multiple buildings and storage closets throughout the facility. LPA noted that facility has adequate supply of PPE for a full census. Administrator and LPA observed ample supply of perishable and non-perishable food supply for a full census. LPA observed clean grounds outside with not visible hazards that would put residents at risk., Over all appearance of facility is clean and properly maintained. LPA did not find any noticeable regulation violations at this time.

Exit interview, report singed and copy provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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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