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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802283
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:47:54 AM

Document Has Been Signed on 09/08/2022 11:47 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:HOBSON SONSHINE HOMEFACILITY NUMBER:
405802283
ADMINISTRATOR:HOBSON, NANCYFACILITY TYPE:
735
ADDRESS:12105 EL CAMINO REALTELEPHONE:
(805) 461-1437
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 6CENSUS: 6DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Julie Hawke, Licensee, and Nancy Hobson, AdministratorTIME COMPLETED:
12:04 PM
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On 9/08/22 at 10:35 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility listed above. LPA met with Julie Hawke, Licensee, and Nancy Hobson, Administrator, and explained the purpose of the visit. Licensee stated that all clients were away at day program.

LPA toured the facility with the administrator and observed the following: The facility has soap and paper towels for residents’ bathrooms, however, paper towels are dispensed to residents upon each use due to the fact that Client #1 (C1) lacks hazard awareness and flushes paper down the toilet. The fire extinguisher is located in the laundry room. The extinguisher is fully charged and was inspected on 11/30/21. 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, however, the licensee did not have a visitor sign-in sheet readily accessible. Licensee states that she has to store the sign-in sheet as C1 removes the sheet. Licensee will send a copy of the visitor sign-in sheet to LPA by end of day 9/8/22. Staff were wearing masks.

At 11:05 am LPA conducted the Infection Control mitigation module with the administrator.

Exit interview conducted and the report emailed to the Licensee and Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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