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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202780
Report Date: 07/05/2024
Date Signed: 07/05/2024 05:19:31 PM


Document Has Been Signed on 07/05/2024 05:19 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:LATU, JASMINEFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 42DATE:
07/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Health and Wellness Director, Dominique FrommoTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit at the facility. The purpose of the visit was to follow up on an Incident Report and Death Report of a resident (R1) who left the facility and passed away outside of the facility. LPA Rai met with Health and Wellness Director (HWD) Dominique Frommo and stated the purpose of today's visit.

LPA Rai interviewed HWD, 4 staff (S2-S5) and 1 resident (R1).

LPA Rai obtained the following copies during today's visit to include but not limited to R1's Physician's Report, R1's Needs and Services Plan and R1's Assessment.

LPA Rai determined this case management needs further investigation.

Exit interview was conducted with Health and Wellness Director (HWD) Dominique Frommo and a copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit RaiTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2024
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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