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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800712
Report Date: 02/22/2023
Date Signed: 02/22/2023 04:51:26 PM

Document Has Been Signed on 02/22/2023 04:51 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: 4DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jerson SorianoTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Required - 1 Year inspection at the facility today. Upon arrival LPA met with Licensee Jerson Soriano. Reason for visit was discussed. Today's annual has an emphasis on infection control practices and procedures.

The LPA, along with Mr. Soriano, toured the physical plant areas inside and outside at approximately 4:15pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

INFECTION CONTROL: During today’s visit, the LPA spoke with staff regarding the facility’s infection control practices. There is one 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.

COMMON SPACES: The common areas were observed. The fire extinguisher observed to be last serviced on 11/2022. 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.

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: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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