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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802103
Report Date: 01/22/2024
Date Signed: 01/22/2024 12:28:08 PM

Document Has Been Signed on 01/22/2024 12:28 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
WOODLAND HILLS N.ASC, 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:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Lori Kelley TIME COMPLETED:
12:40 PM
NARRATIVE
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At 10:11 am, on January 22, 2024, Licensing Program Analyst (LPA) Miller conducted an unannounced annual inspection of the facility above. LPA met with Lori Kelley, Director of Personal Care, and explained the reason for the visit. Kelley advised the Day Program was closed in February of 2019 and is not serving clients at this time.

LPA Miller provided the Director the Entrance Checklist and asked for a physical plant tour. LPA Miller requested an infection control and emergency and disaster plan. A tour of the physical plant was assessed, and the following was noted: LPA observed the license posted, personal rights, LTCO poster, Bill of Rights and CCL complaint poster. Fire extinguishers were last inspected January 15, 2024 and all charged in the green. Hot water temperatures were measured at 10:36 am. The bathroom sink measured at 108.5 degrees Fahrenheit (F).

No deficiencies cited at this time.


Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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