<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200950
Report Date: 09/24/2021
Date Signed: 09/24/2021 03:00:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:SORIANO RESIDENTIAL CARE HOMEFACILITY NUMBER:
435200950
ADMINISTRATOR:SORIANO, MARIAFACILITY TYPE:
740
ADDRESS:227 WEST CAPITOL AVENUETELEPHONE:
(408) 684-4070
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: 3DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Maria SorianoTIME COMPLETED:
03:10 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 Analyst (LPA) Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Maria Soriano Administrator.

LPA toured the facility inside and out to include entry, living room, kitchen, dining, bathroom and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked closet. Toxins, cleaning supplies, knives and sharp objects are secured.

Facility observed to have designated entry point for COVID 19 symptom screening. Bathroom observed to be supplied with hygiene products. Hand washing sign posted in the bathroom. Hand sanitizer available to residents and visitors. LPA observed supply of Personal Protective Equipment (PPE). RO will supply additional PPEs.

LPA reviewed the facility policies and procedures to include screening, visitation, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing.

LPA reviewed report with Maria Soriano Administrator and a copy of this report.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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 1