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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606431
Report Date: 12/09/2021
Date Signed: 12/09/2021 10:25:16 AM

Document Has Been Signed on 12/09/2021 10:25 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
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:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yolanda RuizTIME COMPLETED:
10:20 AM
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At 9:30 am Licensing Program Analysts (LPA) Eleza Jackson conducted an unannounced annual inspection using the Annual Inspection Tool. A physical tour was conducted at 10:10am and the following was observed:

Infection control: Upon arrival, House Manager Yolanda Ruiz took LPA Jackson’s temperature and was asked to sign-in the visitors’ log. Proper signage was observed inside of the facility. Administrator stated they have sufficient PPE supplies for residents and staff.

Food Inspection: LPA Jackson observed there to be sufficient supply of perishable and non perishable foods. Food storage and preparation appear to be clean and inaccessible to pests.

Smoke detectors/carbon monoxide were last tested and were deemed to be in operating condition. Fire extinguisher is up to code.

Resident rooms: All residents bedrooms were properly furnished with appropriate bedding, sufficient lighting, and the room appeared to be clean.

Bathrooms: LPA Jackson observed appropriate hand washing signs posted in the bathroom, grab bars and non-skid mat.

Laundry service: LPA Jackson observed that the cleaning products/chemicals are inaccessible to residents.



Medications are centrally stored and locked.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients.

No deficiencies issued.

Exit interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Eleza Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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