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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202780
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:37:58 AM


Document Has Been Signed on 06/07/2023 11:37 AM - 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:JASMINE LATUFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 32DATE:
06/07/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Jasmine LatuTIME COMPLETED:
11:40 AM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced case management visit. LPA met with facility administrator Jasmine Latu (Admin).

LPA toured the facility and observed it to be in broad compliance with title 22 regulations. LPA reviewed the 7 corrections required during office meeting with licensing on 08/02/2022 to ensure that the facility is currently remaining within compliance. LPA reviewed Administrators qualifications and confirmed Admin's training documentation. During review of resident files, LPA confirmed that all admitted residents had complete admissions agreements with responsible party signatures. LPA reviewed eviction training documentation signed by all managerial stuff that had attended the meeting. No resident's have been evicted since last LPA visit on 11/22/2022.

LPA reviewed staff sign in sheet from a training seminar regarding resident rights and observed it to have been signed by all relevant staff members. LPA reviewed plan of correction and updated plan on submission of incident reports. LPA cross referenced with recent incident reports and confirmed that the facility is in compliance.

LPA reviewed facility plan of operations and observed addendum stipulating facility's plan to adhere to medication training records, as well as facility procedure for ensuring written confirmation of dosages. Facility's medication plan observed to be contained in both resident and staff handbooks. LPA reviewed Technical Support Plan training documentation.

No deficiencies cited curing today's visit. This report was reviewed with facility administrator Jasmine Latu and a signed copy was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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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