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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607799
Report Date: 01/12/2023
Date Signed: 01/12/2023 04:15:23 PM

Document Has Been Signed on 01/12/2023 04:15 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:MARCHELINO ROOSFACILITY TYPE:
735
ADDRESS:3311 TAPO CANYON RDTELEPHONE:
(818) 224-7222
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 4CENSUS: 4DATE:
01/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marchelino Roos - TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent  unannounced Case Management - Incident visit along with Tri-Counties Regional Center Quality Assurance Specialist Ryan Landseadel M.A  to further investigate the (2) incident reports received at the Regional Office on 07/29/2022. Information on the (2) incidents can be found on the initial Case Management - Incident report, which occurred on 08/04/2022. Upon arrival LPA and QAS met with Marchelino Roos and explained the reason for the visit.

On 08/02/2022, LPA conducted initial Case Management - Incident visit and toured facility with Administrator, interviewed staff and reviewed and obtained copies of pertinent documents relevant to the investigation.
On 09/15/2022, LPA obtained and reviewed internal investigation from Administrator via e-mail regarding the (2) incidents. On 01/11/2023, LPA obtained and reviewed Regional Center report via e-mail regarding the (2) incidents. At approximately 02:00pm,  LPA and QAS conducted physical plant, interviewed staff, clients and reviewed and obtained copies of documents pertinent to the incidents.
LPA and QAS records review of internal investigation conducted by facility revealed there was not sufficient evidence to prove that staff were smoking marijuana on site or that a client's personal rights were violated at this time. Furthermore QAS own investigation conducted from 8/30/2022 to 9/30/2022 also did not find sufficient evidence of staff smoking marijuana on site or that a client's personal rights were violated at this time.LPA and QAS interviews with (4) clients, revealed that most did not express any potential or immediate concerns of staff violating their personal rights. Interviews with residents and staff further revealed there was not sufficient evidence to prove that staff were smoking on site. LPA's physical plant did not observe any cigarette butts or any other evidence of smoking on-site.
No immediate health and safety concerns were observed during the visit and no deficiencies cited at this time.

Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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