421703158-6-16-2023-29-AS-DCHZ-CSUVLM-20230616163209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421703158
Report Date: 06/16/2023
Date Signed: 06/16/2023 04:32:55 PM

Document Has Been Signed on 06/16/2023 04:32 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:	SOLVANG FRIENDSHIP HOUSE		FACILITY NUMBER:	421703158
ADMINISTRATOR:	TAMMY WESTWOOD		FACILITY TYPE:	740
ADDRESS:	880 FRIENDSHIP LANE		TELEPHONE:	(805) 688-8748
CITY:	SOLVANG	STATE: CA	ZIP CODE:	93463
CAPACITY:	40	CENSUS: 37	DATE:	06/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Tammy Westwood, Administrator		TIME COMPLETED:	04:45 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 6/16/23 at 11:16 am, Licensing Program Analyst (LPA) Chavez made an unannounced Annual/Required visit to the facility above. LPA met with Tammy Westwood, Administrator, and explained the purpose of the visit. LPA and Administrator toured the physical plant and the following was noted: LPA observed the license posted, Complaint Poster, Bill of Rights and Right to Residential Council, non-discrimination statement, and resident rights. Physical plant was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, all in good condition. The facility maintains a comfortable temperature. The dual smoke and carbon monoxide detectors are hard wired along with a sprinkler system and are operational. Fire extinguishers located in several areas throughout the property were inspected on 3/9/23 and are charged in the green. There are no issues with Fire Clearance. Living rooms, dining room, and activity room furniture were checked and in good condition. The common rooms are clean, safe and sanitary. The courtyards of the facility have outdoor furniture, with shaded area for residents. There are six fountains with running water, however there was a sufficient amount of rocks to ensure little water on the surface. No issues observed. The kitchen was sufficiently stocked with two-day perishable and seven-day non-perishables. The menu was posted for review. Snacks and beverages are available for residents when they want. Foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Refrigerators are kept at 40 F or below and freezers at 0 F degrees. Continued on 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLVANG FRIENDSHIP HOUSE	FACILITY NUMBER: 421703158
	VISIT DATE: 06/16/2023

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
26
27
28
29
30
31
32

Resident rooms are adequately dressed with sheets, pillowcase, mattress pad, and blankets which are in good condition. There is at least one chair, nightstand and sufficient lighting for each resident. There are three resident rooms have “No smoking, oxygen in use” signage on/near their doors, and the same sign is at the front entrance of the buildings. There is enough linen available to change weekly or more, if needed.
Storage closets have sufficient amounts of personal hygiene product which is provided by the licensee and all cleaning products, toxins are stored and locked away inaccessible to residents in care.
The bathrooms were checked for cleanliness and proper operation. The hot water temperature measured between 114.1 F and 116.3 F degrees.
Medications are centrally stored in a locked medication office and in locked medication carts in each building.

Licensee did not complete the emergency disaster plan (LIC 610E). Deficiency cited. Emergency disaster drills are being conducted quarterly.

Exit interview conducted, deficiency cited, and the report and appeal rights given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2