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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802283
Report Date: 09/19/2024
Date Signed: 09/19/2024 10:42:52 AM

Document Has Been Signed on 09/19/2024 10:42 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/
DIRECTOR:
HOBSON, NANCYFACILITY TYPE:
735
ADDRESS:12105 EL CAMINO REALTELEPHONE:
(805) 461-1437
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 6CENSUS: 5DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator, Nancy HobsonTIME VISIT/
INSPECTION COMPLETED:
11:48 AM
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At 8:30AM on 09/19/2024 Licensing Program Analyst (LPA) Jeffries arrived at the facility to conduct and unannounced annual inspection. LPA met with Administrator Nancy Hobson. LPA announced who he is and reason for the visit.
This is a 6 bedroom 3 bathroom, with two living rooms, kitchen and dining-room, with a large deck and large front yard for with multiple seating and umbrellas for shade. Three bedrooms are double client occupancy and the other 3 bedrooms are staff bedrooms. The facility maintains conformity with State Fire Marshall regulations. The facility does not have any bodies of water on the premises, an old empty hot tub with a lid is in a gated fenced area still remains on the property. All outdoor and indoor passageways are free of obstruction. Disinfectants, cleaning solutions are stored in the locked laundry room inaccessible to clients in care. LPA noted that staff have current first aide and CPR certifications. LPA noted that all client rooms have all furniture and linin required by licensing in all rooms. Hot water temperature is maintained within regulation. All toilets, hand washing, and bathing facilities are safe, sanitary, and in operating condition, with liquid soap and paper towels present. Facility has one functioning carbon monoxide detector. Food supplies of 2 days of perishable and 7 days of non-perishable foods are maintained at the facility. All medications are labeled and are maintained in compliance with label instructions. Medication is kept in a safe and locked drawer in the kitchen not accessible to persons other than employees responsible for the supervision of centrally stored medication. All staff have a criminal record clearance. LPA noted that the administrator certificate was current as verified in CCLD website. Client files were reviewed. The licensee ensures that each client receives medical and dental services as needed. All clients in care have complete and separate files with TB results, medical assessments, signed admission agreements, and appraisal needs services plan.
LPA noted that 4 of 5 clients in care are over the age of 60 and Licensee and Administrator are required to address the licensing status from Adult Residential to Residential Care Facility for the Elderly due to collective age of clients in care. No clients present during inspection staff interviewed.
Exit interview conducted and copy of report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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