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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606431
Report Date: 06/21/2022
Date Signed: 06/21/2022 01:50:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/02/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20211202090122
FACILITY NAME:SAILS FALLBROOKFACILITY NUMBER:
197606431
ADMINISTRATOR:ALAN MENDOZA ARCEFACILITY TYPE:
735
ADDRESS:7453 FALLBROOK AVETELEPHONE:
(818) 224-7086
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:4CENSUS: 4DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yolanda RuizTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Client sustained seizure while in care.
Client not administered medication as prescribed.
Client's medication not available to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with house manager Yolanda Ruiz and explained the reason for this visit.
Regarding the allegations it is alleged that client #1 (C1) sustained a seizure due to C1 not being given their medication as prescribed and that C1's medication was not available to them. LPA conducted an interview with facility staff regarding these allegations from 9:30-10:30am. LPA also reviewed an incident report and documentation related to the allegation from 10:30-11am. LPA obtained copies of the incident report and documents. LPA had previously spoken to R1's conservator regarding the incident. Information obtained from interviews reveal that on 11/30/21 medication was delivered from the pharmacy to the facility. After reviewing the medication facility staff notified the pharmacy that two of C1's medication for December 2021 cycle was missing from the medication that was delivered. Pharmacy called back and stated they were unable to get in contact with R1's doctor regarding the physician. On 12/1/21 facility staff contacted the pharmacy again regarding the missing medication and at this time it was noted that C1 had missed the morning medication of
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20211202090122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAILS FALLBROOK
FACILITY NUMBER: 197606431
VISIT DATE: 06/21/2022
NARRATIVE
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 the prescribed medications. During this time C1 was observed to start having a seizure, emergency services were then called. Before emergency services arrived the pharmacy came by and dropped off C1's medication. Emergency services checked C1 and were notified about C1 missing their medication and were informed the medication was now available. Decision was made to give C1 the medication they were missed and C1 was to be monitored for an hour. After an hour C1 was declared medically stable and did not need to go to the hospital. Facility contacted C1's conservator who agreed that C1 did not need to go to the hospital. Based on the information obtained through interviews and documentation it was found that C1 did have a seizure due to not receiving their medication timely but it was not the facilities fault. Facility contacted the pharmacy the day before when they realized C1 did not receive their medication and followed up again the next morning. As a result of the pharmacy failing to drop off the medication timely the facility decided to go with another pharmacy. Therefore all three allegations are deemed Unsubstantiated at this time. No deficiencies cited. Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2