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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800712
Report Date: 02/16/2022
Date Signed: 02/16/2022 04:56:54 PM

Document Has Been Signed on 02/16/2022 04:56 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SORIAN'S CARE HOMEFACILITY NUMBER:
565800712
ADMINISTRATOR:SARA SORIANOFACILITY TYPE:
735
ADDRESS:5464 KATHERINE ST.TELEPHONE:
(805) 527-0524
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 4CENSUS: 3DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Carolina Caballero & David Serrano, StaffTIME COMPLETED:
04:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Required - 1 Year inspection at the facility today. At 2:30pm the LPA met with staff at the facility and explained the reason for the inspection. Staff contacted one of the Administrator's - Gerson Soriano and reason for LPA's visit was discussed.
Today's annual has an emphasis on infection control practices and procedures.
The LPA, along with Staff, toured the physical plant areas inside and outside at approximately 2:45pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

COMMON SPACES: The common areas were observed. The fire extinguisher observed to be last serviced on 11/3/2021. The smoke alarms and carbon monoxide detectors were tested in the common area and observed operational. The facility has a sufficient supply of perishable and non-perishable food. Sufficient disinfecting/cleaning supplies observed (locked). BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: There are two bathrooms. Bathrooms had hand soap, paper towels, and signs regarding proper hand washing. Backyard observed clear of any hazardous items. Passageways observed clear/no obstruction. INFECTION CONTROL: During today’s visit, the LPA spoke with staff regarding the facility’s infection control practices. There is 1 entry into the facility. Upon entry, the facility has a central entry point for symptom screening. The LPA observed an adequate supply of Personal Protective Equipment (PPE). The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

The following observation made during the physical plant tour: LPA observed part of the laundry/storage area occupied as a sleeping area for live-in staff's kids. LPA discussed with staff and Licensee/Administrator Gerson Soriano about this arrangement. LPA informed Mr. Soriano that the space could not be used as a bedroom unless it is cleared by the fire department. Mr. Soriano agreed to clear out the area (remove bed). The following deficiency observed was cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Exit interview held with staff. Copy of the report emailed to Licensee/Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2022
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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Document Has Been Signed on 02/16/2022 04:56 PM - It Cannot Be Edited


Created By: Zabel Chochian On 02/16/2022 at 04:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SORIAN'S CARE HOME
FACILITY NUMBER: 565800712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85087(a)(3)(A)
85087 Buildings and Ground: (a)In addition to Section 80087, bedrooms must meet, at a minimum, the following requirements:
(3) No room commonly used for other purposes shall be used as a bedroom for any person.
(A) Such rooms shall include but not be limited to halls, stairways, unfinished attics or basements, garages, storage areas, and sheds, or similar detached buildings.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview with staff and Mr. Soriano, the licensee did not comply with the section cited above by allowing staff's children to occupy the designated storage area as living/sleeping area. This poses an immediate health and safety risk to persons in the home.
POC Due Date: 02/16/2022
Plan of Correction
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Licensee/Administrator Gerson Soriano agreed to not have anyone use the storage area as a living/sleeping space at this time.
Mr. Soriano agreed to remove the bed from the storage area and provide photo of the storeage area and submit photo as proof of correction. Also provide plan of action for the live in staff and their childern.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Desaree Perera
LICENSING EVALUATOR NAME:Zabel Chochian
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2022


LIC809 (FAS) - (06/04)
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