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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606431
Report Date: 05/23/2023
Date Signed: 05/23/2023 10:27:50 AM

Document Has Been Signed on 05/23/2023 10:27 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SAILS FALLBROOKFACILITY NUMBER:
197606431
ADMINISTRATOR:DANIELA MOSQUERAFACILITY TYPE:
735
ADDRESS:7453 FALLBROOK AVETELEPHONE:
(818) 224-7086
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 4CENSUS: 4DATE:
05/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:TIME COMPLETED:
10:37 AM
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Licensing Program Analyst (LPA) Antonia Alvizar conducted unannounced case management to the facility to follow up of the notice sent to the facility regarding an immediate removal of the Individual #1 (I1) from the facility due to issues related the criminal record clearance.
On 04/13/2023 the Criminal Record Background Check Bureau sent a notice to the facility informing that I1 must be removed from the facility. On 05/02/2023 the Criminal Record Background Check Bureau Notice was returned to CCLD with undeliverable label because facility address is wrong.

During this visit LPA Alvizar spoke with the ­­­House Manager, Jamie Chavez- Callejas, who stated that they don’t have a staff with that name. At 9:15AM LPA reviewed the facility staff roster and staff schedule. The documents did not identify the name of I1. LPA Alvizar provided a copy of the letter to Jamie and requested to complete the confirmation of removal to clarify that I1 has never worked for the facility.

Based on observation, interviews and evidence obtained through the facility documents, the LPA Alvizar has verified the individual is not present, employed or residing at the facility.

Verification of removal was completed and signed during this visit and the document was collected by LPA Alvizar.

No other health and safety hazard is noted during this visit.


An exit interview was conducted, and a copy of report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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