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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401703699
Report Date: 11/01/2024
Date Signed: 01/15/2025 03:31:37 PM

Document Has Been Signed on 01/15/2025 03:31 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/
DIRECTOR:
NANCY HOBSONFACILITY TYPE:
735
ADDRESS:244 SAN AUGUSTINE DR.TELEPHONE:
(805) 221-5472
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 4CENSUS: 4DATE:
11/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Licensee, Holly HobsonTIME VISIT/
INSPECTION COMPLETED:
11:43 AM
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At 9:30am on 11/01/2024, Licensing Program Analysts (LPA) Mark Jeffries conducted an unannounced required annual inspection visit. LPA met with Licensee, Holly Hobson. LPA announce who he is and the reason for the visit.

LPA toured facility with Licensee. There are 4 clients, two of which clients are married share one room. The other two clients have single occupancy rooms. Clients share one bathroom. The Licensee has a bathroom just outside their room on the south side of the home. Medications locked in hallway cabinet. This facility the Licensee has 4 children (ages 12, 9, 6 and 2) that live at the home as well as the Licensee. The facility is maintained in conformance with state fire marshal regulations. Smoke detectors and carbon monoxide detectors functioning throughout the facility. Fire extinguisher was fully charged. Inside and outside passageways are free from obstruction. There are no bodies of water on the facility property. The facility temperature was 71 degrees F. Hot water temperature was check and within regulation range of 105*-120*(f). Residents’ rooms are appropriately furnished with adequate lighting. LPA observed more than two days of perishable and more than seven days of non-perishable food. Last emergency disaster drill was performed and documented on 10/09/2024. LPA noted that the facility exits and pathways were free and clear of obstacles and debit. LPA reviewed Emergency Disaster Plan, Infection control Plan, reviewed staff and resident’s files, and conducted a sample medication audit. LPA noted that no violations or citations were issued on the facility walk through. No changes from the prior year inspection.

Licensee and LPA reviewed all of the control tool modules. During the review LPA did not discover any technical, violations or citations. At this time there are no citations on this annual facility inspection.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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