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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607799
Report Date: 08/04/2022
Date Signed: 08/04/2022 01:53:55 PM

Document Has Been Signed on 08/04/2022 01:53 PM - 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SAILS SIMIFACILITY NUMBER:
197607799
ADMINISTRATOR:AYOBAMI TEMILOLUWAFACILITY TYPE:
735
ADDRESS:3311 TAPO CANYON RDTELEPHONE:
(818) 224-7222
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 4CENSUS: 4DATE:
08/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marchelino Roos - Administrator TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management - Incident visit for (2) incident reports received at the Regional Office on 07/29/2022. Upon arrival LPA was met by Administrator Marchelino Roos

The incident reports were authored by Administrator indicated that on 07/27/2022, at approx 5:30pm, Client 1 (C1) stated to Administrator that C1 witnessed (2) staff members smoking marijuana while on site. Administrator initiated an internal investigation with staff and clients on site then looked to conclude the investigation the next day. During that time Administrator left the facility, it was reported that Staff 1 (S1) spoke to C1 in an aggressive manner so the police were called to the facility as C1 had immediate concerns for C1's health and safety.

The second incident report authored by Administrator indicated that on 07/27/2022, at approximately 8:30pm, C1 informed Administrator of S1 physically abusing and violating the personal rights of Client 2 (C2) on multiple occasions.
An Internal investigation is currently being conducted by Administrator for both incidents and they are looking to complete it by early next week.

At approximately 11:35am, LPA conducted physical plant, interviewed staff and reviewed and obtained copies of documents pertinent to the incidents.

No immediate health and safety concerns were observed during the visit. Further investigation is required at this time.

Exit interview conducted. Report issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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