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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001736
Report Date: 07/31/2024
Date Signed: 07/31/2024 01:15:58 PM

Document Has Been Signed on 07/31/2024 01:15 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VOCATIONAL VISIONSFACILITY NUMBER:
306001736
ADMINISTRATOR/
DIRECTOR:		BOB HENNINGFACILITY TYPE:
775
ADDRESS:23612 ALAMBRETELEPHONE:
(949) 837-7280
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 160CENSUS: 75DATE:
07/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Bob HenningTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit in conjunction with complaint number 22-AS-20240722153616. LPA met with the Director of Operations Bob Henning and explained the reason for the visit. During the course of the complaint investigation it was discovered that the complaint incident was not reported to the Agency (Community Care Licensing). This issue of not reporting the incident is not part of the original complaint. The incident in question that took place on July 17, 2024 involved Client 1 (C1) and Staff 1 (S1), must be reported to the Agency, but it was not reported. LPA verified with the Director of Operations that the incident that took place on July 17, 2024 was not reported to the Agency. Based on the information gathered deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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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Document Has Been Signed on 07/31/2024 01:15 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 07/31/2024 at 11:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VOCATIONAL VISIONS
FACILITY NUMBER: 306001736

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2024
Section Cited
CCR
82061(a)

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Upon the occurrence, during the hours the day program is providing services to the client, of any of the events specified in Section 82061(a)(1)... a written report containing the information specified in Section 82061(a)(2) shall be submitted to the licensing agency within seven days following the occurrence of the event.
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Licensee agrees to submit an incident report to the Agency involving the incident that took place on July 17, 2024, and to report all future incidents to the Agency in compliance with CCR 82061 Reporting Requirements.
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This requirement was not as evidenced by, an incident took place on July 17, 2024 involving Client 1 (C1) and Staff (1) that must be reported was not reported to the Agency, which poses/posed a potential health, safety or personal rights risk to persons 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:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


LIC809 (FAS) - (06/04)
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