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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802297
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:00:47 PM

Document Has Been Signed on 06/07/2022 01:00 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 - LEGATO HOMEFACILITY NUMBER:
405802297
ADMINISTRATOR:DEBRA BERTRANDOFACILITY TYPE:
735
ADDRESS:3750 LA LUZ RD.TELEPHONE:
(805) 464-4880
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 4CENSUS: 4DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Thomas Bundren, Crisis Services ManagerTIME COMPLETED:
01:15 PM
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On 6/07/22 at 11:45 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility above. LPA met with Thomas Bundren, Crisis Services Manager, and explained the purpose of the visit.

LPA toured the facility with the Crisis Services Manager and observed the following: The facility has infection control signage at the front door, however, the current visitor sign says “No Visitors Allowed.” Licensee will replace sign with signage allowing visitors, take a photo, and send to LPA. There is a staff sign-in sheet, however, there is not an area on the sign-in sheet for visitor names. Licensee will update the sign-in sheet or add a visitor sign-in sheet, take a photo, and send to LPA. There is signage throughout the facility on cough etiquette, handwashing, 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 (3). Fire extinguishers (4) are located in the front door entry, the hall leading to resident bedrooms, near the office, and in the garage. The extinguishers are fully charged. They were inspected on 4/21/21 and have expired. Licensee will have fire extinguishers inspected, take photos of tags and surrounding area, and send to LPA. Crisis Services Manager stated that residents’ dentist information is not currently on the emergency info sheet. Manager will add to the face sheet and send a copy of the revised sheets for all (4) residents to LPA. The blinds in the resident bedroom next to the office are broken. Licensee will repair or replace blinds, send a photo to LPA. All corrections must be sent to LPA on or before 6/15/22.

At 12:10 pm, LPA conducted the Infection Control mitigation module with the crisis services manager. No deficiencies cited.

Exit interview conducted and report emailed to the administrator and crisis services manager.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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