<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
435202780
Report Date:
05/10/2022
Date Signed:
05/10/2022 04:26:15 PM
Document Has Been Signed on
05/10/2022 04:26 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
CCLD Regional Office
,
2580 N. FIRST STREET, STE. 350
SAN JOSE
,
CA
95131
FACILITY NAME:
SONNET HILL
FACILITY NUMBER:
435202780
ADMINISTRATOR:
HAHKLOTUBBE, DAVID
FACILITY TYPE:
740
ADDRESS:
429 MERIDIAN AVE
TELEPHONE:
(408) 731-0019
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95126
CAPACITY:
80
CENSUS:
19
DATE:
05/10/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
David Hahklotubbe
TIME COMPLETED:
04:45 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 Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator David Hahklotubbe.
LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed a visitor screening area with a temperature checking machine and a visitor questionnaire symptom screening form. LPA Marrufo observed the outside area of the facility and observed the exits to be clear of obstructions.
LPA Marrufo observed the dinning and kitchen areas. The kitchen area had a perishable food supply of at least 3 days and a non-perishable food supply of at least 7 days. LPA Marrufo observed there to be a PPE supply of at least 30 days.
No deficiencies were cited at this time as per California Code of Regulations Title 22.
This report was reviewed with David Hahklotubbe and a copy of the report was provided.
SUPERVISOR'S NAME:
Jackie Jin
TELEPHONE:
(714) 319-3786
LICENSING EVALUATOR NAME:
David Marrufo
TELEPHONE:
(650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE:
05/10/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/10/2022
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