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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
496803924
Report Date:
09/12/2022
Date Signed:
09/12/2022 03:00:12 PM
Document Has Been Signed on
09/12/2022 03:00 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
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
SONOMAMODELX
FACILITY NUMBER:
496803924
ADMINISTRATOR:
ALEXANDER VARSHAVSKY
FACILITY TYPE:
740
ADDRESS:
765 DONALD STREET
TELEPHONE:
(415) 264-5486
CITY:
SONOMA
STATE:
CA
ZIP CODE:
95476
CAPACITY:
32
CENSUS:
21
DATE:
09/12/2022
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Adminstrator/Licensee Alexander Varshavsky
TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 09/12/2022 to follow up with Plan of Correction. LPA met with administrator/licensee Alexander Varshavsky.
Upon arrival interior temperature was observed at 84 degrees F which is within regulation. Exterior temperature was 85 degrees F during the inspection. LPA and administrator discussed plans going forward to ensure temperature stays within a comfortable range. Licensee intends to purchase portable air conditioners and place them throughout the facility within the week. Licensee has been in contact with air conditioner installers for a centralized and permanent solution. Licensee to submit pictures of portable AC units to LPA.
Exit interview conducted with administrator/licensee and a copy of the report was emailed to the licensee.
SUPERVISOR'S NAME:
Kimberley Mota
TELEPHONE:
(707) 588-5051
LICENSING EVALUATOR NAME:
Erik Gonzalez Campos
TELEPHONE:
(707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE:
09/12/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/12/2022
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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