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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208893
Report Date: 05/11/2024
Date Signed: 05/15/2024 09:23:50 AM

Document Has Been Signed on 05/15/2024 09:23 AM - 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SAILS VIIFACILITY NUMBER:
157208893
ADMINISTRATOR/
DIRECTOR:		MARQUEZ, JOSEFACILITY TYPE:
735
ADDRESS:4013 REDFORD CTTELEPHONE:
(661) 473-2339
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 4CENSUS: 4DATE:
05/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:District Manager Ty SchererTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. During the course of the investigation LPA found additional deficiencies. LPA met with District Manager Ty Scherer.

After reviewing records and conducting interviews, it was found night staff left around 7:55 AM or 8 AM on 5/4/24. S1 was here with 4 clients. S2 arrived at the facility around 8:15 AM. There was no other staff present other than S1 when C2 was injured.

Refer to 809D.


A copy of this report was provided with appeal rights and plan of correction.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2024
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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Document Has Been Signed on 05/15/2024 09:23 AM - It Cannot Be Edited


Created By: Shawna Doucette On 05/11/2024 at 09:49 AM
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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SAILS VII
FACILITY NUMBER: 157208893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2024
Section Cited
CCR
85065.5(a)(1)

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85065.5 Day Staff-Client Ratio (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met:
(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients.
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Plan of Correction POC Licensee agrees to conduct a supervision policy training to all staff regarding staff to client ratios by POC due date. POC cleared during visit.
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This requirement was not met as evidenced by Licensee had 1 staff for 4 clients, which poses an immediate health safety and or personal rights risk to clients in care.
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2024


LIC809 (FAS) - (06/04)
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