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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800712
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:53:14 PM

Document Has Been Signed on 03/07/2024 03:53 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:
03/07/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jerson SorianoTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Annual Continuation Visit to the facility to continue the annual inspection visit initiated on 02/11/2024. Upon arrival, there was one (1) staff and two (2) clients. The other two (2) clients were still in day program. LPA met with Administrator, Jerson Soriano and informed them of the reason for the visit. Entrance interview.

During today’s visit, at 2:45 p.m., the LPA toured the physical plant areas to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations and conducted a medication review. The following was noted:

The LPA observed two (2) client restrooms, which were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The LPA observed four (4) client bedrooms, which were furnished appropriately and had sufficient lighting. The LPA inspected the kitchen area at 2:55 p.m. The facility has a sufficient supply of perishable and non-perishable food. The pool is kept secured from clients. All indoor and outdoor passageways were free from obstructions in case of an emergency.

Medications: Medications review began at approximately 3:15 p.m. The medications are centrally stored in a locked cabinet adjacent to the living room. All medications including PRNs were labeled, stored, and locked inaccessible to clients. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

LPA conducted interviews with two (2) clients during the inspection.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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