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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802103
Report Date: 02/10/2022
Date Signed: 02/10/2022 04:09:32 PM

Document Has Been Signed on 02/10/2022 04:09 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:ATTERDAG VILLAGE OF SOLVANGFACILITY NUMBER:
425802103
ADMINISTRATOR:PARKER, CHRISTOPHER WFACILITY TYPE:
775
ADDRESS:636 ATTERDAG ROADTELEPHONE:
(805) 688-3263
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 8CENSUS: 0DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Chris Parker, Administrator, and Lorie Kelley, Director of Memory CareTIME COMPLETED:
11:30 AM
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At 9:50 am, on 2/10/2022, Licensing Program Analysts (LPAs) Darlene Chavez and Jenny Olson conducted an unannounced annual infection control inspection of the facility above. LPAs met with Chris Parker, Administrator, and Lorie Kelley, Director of Memory Care (Director of MC), and explained the reason for the visit. LPAs, Administrator, and Director of MC toured the facility. Administrator states the Day Program has been closed since March 2020 and they are not serving clients at this time.

LPAs’ initial tour of the facility resulted in observations which were immediately corrected. LPAs were screened upon entry to the facility by staff. Between 10:00 am and 10:10 am, the kitchen water temperature was recorded at 112.4 F, and the bathroom at 110 F. At 10:15 am, LPAs observed a bottle of hand sanitizer on a cabinet in the common area. Director of MC immediately placed the hand sanitizer in a locked office. At 10:17 am, LPAs observed a bag of potting soil on the outside patio attached to the Day Program. Administrator immediately placed the soil in an inaccessible area.

At 10:20 am, LPAs conducted the Infection Control mitigation module with the Administrator. No deficiencies found.

Exit interview conducted and report emailed to the Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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