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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802103
Report Date: 01/12/2023
Date Signed: 01/12/2023 11:56:28 AM

Document Has Been Signed on 01/12/2023 11:56 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: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:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Chris Parker, Administrator, and Lori Kelley, Director of Personal CareTIME COMPLETED:
12:20 PM
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At 10:57 am, on 1/12/23, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced annual infection control inspection of the facility above. LPA met with Chris Parker, Administrator, and Lori Kelley, Director of Personal Care, and explained the reason for the visit. Director states the Day Program has been closed since March 2020 and they are not serving clients at this time.

LPA toured the facility with the Director and observed the following: LPA was screened upon entry to the facility. All staff are wearing masks. The facility has infection control signage. The facility has soap and paper towels in the common area bathroom. A fire extinguisher is located near in the dining room area. The extinguisher is fully charged and was inspected on 4/19/22.

At 11:24 am, LPA conducted the Infection Control mitigation module with the Director. No deficiencies cited.

Exit interview conducted and report emailed to the Administrator and Director.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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