<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208899
Report Date: 01/12/2024
Date Signed: 01/12/2024 11:59:49 AM

Document Has Been Signed on 01/12/2024 11:59 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 STELLARFACILITY NUMBER:
157208899
ADMINISTRATOR:VALDEZ, JOSE MARQUEZFACILITY TYPE:
735
ADDRESS:11708 STELLAR AVETELEPHONE:
(661) 570-3298
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
01/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Jose Marquez Valdez
Ty Scherer		TIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/12/2024, LPA Medina conducted an unannounced Case Management visit to follow up on a self reported incident that occurred on 12/31/23, involving S1 leaving the facility without authorization prior to shift ending (4:00 PM to 12:00 AM) resulting in R1, R2, R3 and R4 being left unattended for approximately 20 minutes prior to S2 arriving for NOC scheduled from 12:00 AM to 8:00 AM.

S1 was immediately placed on Administrative Leave and then subsequently terminated on 1/01/2024.

All staff were provided training on 1/4/2024 regarding Individual Supervision and Neglect Prevention. All training records were provided to LPA during Case Management visit. LPA received update LIC 500, LIC 9020, Staff Schedule, staff statement, Copy of Employee Counseling and Corrective Action Form, and Kern Regional Center Corrective Action Plan.

Deficiency cited on attached 9099D. A deficiency is being cited based on incident that occurred in accordance with the California Code of Regulations, Title 22. An Immediate Civil Penalty is being assessed in the amount of $500. See LIC421IM for more details.

An exit interview was conducted with licensee. Deficiency cleared at time of visit. A copy of this report and appeal rights were discussed and provided to the licensee at the time of visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/12/2024 11:59 AM - It Cannot Be Edited


Created By: Melinda Medina On 01/12/2024 at 11:20 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 STELLAR
FACILITY NUMBER: 157208899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2024
Section Cited
HSC
1548(c)(3)

1
2
3
4
5
6
7
(c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations:
1
2
3
4
5
6
7
Training provided to all staff on 1/4/2024. All records provided to LPA during Case Management visit.

DEFICIENCY CLEARED AT TIME OF VISIT
8
9
10
11
12
13
14
(3) Absence of supervision, as required by statute or regulation.
This was not met as evidenced by: R1, R2, R3 and R4 were left unsupervised for approximately 20 minutes on the night of 12/31/23.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Melinda Medina
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2