<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801389
Report Date: 08/06/2022
Date Signed: 08/06/2022 02:01:57 PM

Document Has Been Signed on 08/06/2022 02:01 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:OPTIONS FAMILY OF SERVICES-SONATA HOMEFACILITY NUMBER:
405801389
ADMINISTRATOR:FRAN WALKERFACILITY TYPE:
735
ADDRESS:5755 VALENTINA AVENUETELEPHONE:
(805) 462-8544
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 3CENSUS: 3DATE:
08/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kwame Doss, Supervisor and Deanne Goodwin, Community Support SpecialistTIME COMPLETED:
02:21 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/06/22 at 1:00 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility above. LPA met with Supervisor Kwame Doss, and Community Support Specialist Deanne Goodwin, and explained the purpose of the visit.

LPA toured the facility with the supervisor and observed the following: The facility has infection control signage at the front door and signage throughout the facility on handwashing, cough etiquette and use of masks. Upon entry to the facility, LPA was screened. Staff are wearing masks. The facility has soap and paper towels in resident bathrooms and in the kitchen. The fire extinguishers (3) are located in the dining room, end of hallway near office, and in the garage. The extinguishers are fully charged and were inspected on 6/15/22. The facility has a trash can in the kitchen, however, it does not have a sealed lid. Supervisor will place a sealed trash can in the kitchen, take a photo, and send to LPA. The exterior gate on the east side of the facility needs a spring to auto-close the gate. Supervisor will install, video the gate closing, and send the video to LPA. Corrections should be sent to LPA by 8/13/22.

At 1:24 pm, LPA conducted the Infection Control mitigation module with the supervisor. No deficiencies cited.

Exit interview conducted and report emailed to the CEO Debbie Bertrando.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1