425850229-12-28-2021-29-AS-ADIZ-CA663X-20211228192751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425850229
Report Date: 12/28/2021
Date Signed: 12/28/2021 07:29:05 PM

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:	A CASA TUNNELL		FACILITY NUMBER:	425850229
ADMINISTRATOR:	SORIANO, APRILYN A		FACILITY TYPE:	740
ADDRESS:	958 E TUNNELL STREET		TELEPHONE:	(805) 922-7670
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	6	CENSUS: 4	DATE:	12/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Aprilyn Soriano		TIME COMPLETED:	03:45 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	Licensing Program Analysts (LPA) Diaz conducted a pre-licensing visit to the facility above at 8:39am. LPA met with Applicant Aprilyn Soriano and Consultant, Debra Ermac and Administrator Cheryll Ate. The applicant has obtained fire clearance for (6) non-ambulatory and (4) bedridden residents, for a total capacity of six (6) Residents. Beginning at 9:07am, LPA inspected the proposed facility for Fire Safety, Personal Accommodations, and Food Service. All hard-wired smoke alarms were functioning properly at this time. 1 out of 2 carbon monoxide detectors was not functioning. LPA observed one fire extinguisher to be fully charged and newly purchased. Paint, windows, blinds, and floors are in good repair. There are no firearms on the premises. The common living and dining areas are clean and properly furnished. A working telephone is present. The facility has a comfortable temperature of 74 degrees. The proposed facility has 4 resident bedrooms total. There are 2 single-occupancy bedrooms and 2 double occupancy bedroom designated for resident use. The 3 resident bedrooms were furnished and contained beds, chairs, bedside tables and lamps. All beds have sheets, pillows, and mattress pads. 1 double occupancy room is missing a bedroom dresser and closet door hinge is broken. There is also an ample supply of linen, towels and paper products. The proposed facility has (2) full bathrooms for resident use. LPA observed a night-light present in the main hallway. Hot water measured at 113.2 degrees Fahrenheit at approx. 9:50am The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of non-perishable food is present, as well as, a seven-day supply of water. A locked medication cabinet and First aid kit was observed to be complete.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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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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: A CASA TUNNELL	FACILITY NUMBER: 425850229
	VISIT DATE: 12/28/2021

NARRATIVE

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There is space to lock Chemicals in the garage and under the kitchen sink and in the laundry room. Sharp items are stored in a locked kitchen drawer. The laundry room is located next to the kitchen and supplies will be stored in the locked garage cabinets. The building and grounds are free from hazard. LPA and Applicant Aprilyn Soriano completed component III

The following needs to be completed/proof submitted prior to the facility being licensed:
1. Provide Dresser in bedroom 1.
2. Provide a functioning Carbon Monoxide detector
3. Complaint poster needs to be size 20 by 26 color
4. Repair closet door hinge

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.
Exit interview conducted and report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

LIC809 (FAS) - (06/04)

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