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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401703699
Report Date: 10/20/2022
Date Signed: 10/20/2022 05:32:57 PM

Document Has Been Signed on 10/20/2022 05:32 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:HOBSON SONSHINE HOME #2FACILITY NUMBER:
401703699
ADMINISTRATOR:NANCY HOBSONFACILITY TYPE:
735
ADDRESS:244 SAN AUGUSTINE DR.TELEPHONE:
(805) 221-5472
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 4CENSUS: 4DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Hollie Hobson / LicenseeTIME COMPLETED:
10:10 AM
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 At 8:00am on 10/20/2022, Licensing Program Analyst (LPA) Jeffries arrived unannounced to conduct an annual infection control inspection. LPA met with Licensee Hollie Hboson and announced the reason for the visit.

At 9:05am Licensee and LPA conducted a facility tour. This is a 4 bedroom 2 bathroom, kitchen, living room and backyard outdoor area with shading for residents in care. LPA observed 2 days of perishable and 7 days of nonperishable foods. LPA observed all fire extinguishers to be in compliance with regulations. LPA observed all fire detractors and carbon monoxide detectors to be in working order. LPA noted that the water from faucets from the kitchen and bathroom one to be with in regulation range of 95*f to 120*f. LPA did not observe and hazards or obvious dangers to residents in care. LPA observed the facility to be clean and organized and every appliance to be in good working order.
Licensee and LPA conducted the infection control module of the annual inspection tool. LPA noted that all questions were answered in the affirmative "Yes: and there were no deficiencies cited on this annual inspection.

Exit interview, report singed and report emailed.


SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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