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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606597
Report Date: 06/21/2022
Date Signed: 07/15/2022 09:57:30 AM

Substantiated


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
06/14/2022 and conducted by Evaluator Melissa Ruiz
COMPLAINT CONTROL NUMBER: 31-AS-20220614165323
FACILITY NAME:WESTPORT HOMEFACILITY NUMBER:
197606597
ADMINISTRATOR:REX RETOLADOFACILITY TYPE:
740
ADDRESS:10252 EAST AVENUE STELEPHONE:
(661) 944-5779
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY:20CENSUS: 14DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Russel Cambiado - StaffTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility gates are locked.
INVESTIGATION FINDINGS:
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On 7/15/22 at 10:30 a.m., Licensing Program Analysts (LPAs) Ruiz and Stamps will be issuing a civil penalty in relation to the deficiency issued 6/21/22. At 10:30 a.m. LPAs Melissa Ruiz and Joscelyn Martinez arrived at the facility mentioned above to conduct a complaint investigation. Upon arrival, LPAs observed that there was a chain and a padlock on the gate, but the gate was open. LPAs called the facility Administrator Roda Garabato at 11:05 a.m. an entrance interview was conducted. LPAs explained the purpose of the visit.
It was alleged that the facility gates are locked. From 11:05 a.m. to 11:20 a.m. LPAs interviewed the Administrator and one staff, both of which stated that the gate has been kept locked before. LPAs conducted record review and did not observe an approval of locked exterior doors or locked perimeter fence gates in the fire clearance. Based on interview and record review, this allegation is substantiated.
Deficiencies were issued per CA code of Regulations Title 22. LPA Ruiz and Stamps will be issuing a civil penalty in relation to the deficiency issued 6/21/22. Pursuant to Title 22 Division 6 of the CA Code of Regulation, a $500 Civil Penalty issued.See 9099D's included with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
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-20220614165323
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: WESTPORT HOME
FACILITY NUMBER: 197606597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2022
Section Cited
CCR
87705(I)(2)
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CCR 87705(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates.
This requirement is not met as evidenced by:
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Administrator is no longer locking the exterior permiter gate with a padlock. The padlock and chain will be removed completely and a written statement of all staff acknowledging gate will not be locked will be submitted by the POC due date. Additionally, an immediate $500.00 civil penalty has been issued.
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Based on interviews and record review, the facility did not ensure that it had the appropriate fire clearance before locking the property's gated perimeter fence which poses an immediate risk to the residents 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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC9099 (FAS) - (06/04)
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