435202780-11-28-2023-26-AS-CDOS-CY22FV-20231128162211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202780
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:22:14 PM

Document Has Been Signed on 11/28/2023 04:22 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 HILL		FACILITY NUMBER:	435202780
ADMINISTRATOR:	JASMINE LATU		FACILITY TYPE:	740
ADDRESS:	429 MERIDIAN AVE		TELEPHONE:	(408) 731-0019
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	80	CENSUS: 35	DATE:	11/28/2023
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Jasmine Latu		TIME COMPLETED:	04:30 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) Christine Dolores conducted an unannounced case management - Legal/Non-compliance visit. LPA met with Administrator (ADM) Jasmine Latu. LPA toured the facility with ADM to include the first floor, second floor, and third floor. 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 observed ADM's training documentation to include an up-to-date Administrator Certificate and Technical Support Plan training documentation from January 2023. During review of resident (R1 - R4) files, LPA observed that all admitted residents had complete admissions agreements with responsible party signatures. LPA reviewed eviction training documentation signed by all managerial staff that had attended the meeting dated 07/2022. ADM states a plan to complete an updated in-service training with managerial staff by end-of-week. Facility issued a 30-day eviction notice on 06/29/2023. Eviction notice observed to be in compliance with Title 22 regulations. ADM was unable to produce the staff training documentation regarding resident rights that was completed in July 2022. ADM states a plan to complete the in-service training with all staff and directors before end-of-week. LPA reviewed the facility's plan on submission of incident reports and communication with resident's physician and responsible party. ADM states a plan to complete the in-service training documentation regarding incident reporting and proper communication when there is a change of condition before end-of-week. ADM will send the training documentation to LPA Dolores by end-of-week. SEE LIC809-C.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 11/28/2023

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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 employee handbook. Facility completed a medication in-service training in October 2022. ADM states the nurse completed a more recent in-service training, however, the documentation does not indicate the training topics and date. ADM states they plan to re-train the proper staff to include the updated training documentation. ADM will submit the training documentation to LPA Dolores by end-of -week.

LPA Dolores advised ADM regarding the importance of adhering to the facility's corrective action plan that was developed on 08/02/2022, to ensure the facility's stays within compliance of Title 22 regulation. ADM stated understanding.

No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator Jasmine Latu and a copy of the report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC809 (FAS) - (06/04)

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