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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003867
Report Date: 06/17/2022
Date Signed: 06/17/2022 01:39:51 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2022 and conducted by Evaluator Babatunde Aborchie
PUBLIC
COMPLAINT CONTROL NUMBER: 22-CR-20220228113014
FACILITY NAME:SAILS OC CRISISFACILITY NUMBER:
306003867
ADMINISTRATOR:LORI CONTIFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:3CENSUS: 2DATE:
06/17/2022
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff failed to seek medical attention for minor in a timely manner
Staff are not providing appropriate care and supervision to residents in care
INVESTIGATION FINDINGS:
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On June 16, 2022, Licensing Program Analyst (LPA), Babatunde Aborchie met with Sails OC Administrator Crystal Garcia to review the complaint investigative findings for the above stated allegations. During the investigation, LPA interviewed two staff, two of two clients (C1 and C2) residing in the facility, Administrator, and reviewed medication records.
On February 28, 2022 the Department received allegations that staff failed to seek medical attention for minor in a timely manner and staff are not providing appropriate care and supervision to residents in care.
Regarding the allegation that staff failed to seek medical attention for minor in a timely manner, a confidential interview stated that facility administrator (FA) was immediately notified. Another confidential interview stated that FA immediately made a telephone call to C1’s primary doctor, FA was instructed to have staff observe C1 at the facility for any unusual changes.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Babatunde Aborchie
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2022 and conducted by Evaluator Babatunde Aborchie
PUBLIC
COMPLAINT CONTROL NUMBER: 22-CR-20220228113014

FACILITY NAME:SAILS OC CRISISFACILITY NUMBER:
306003867
ADMINISTRATOR:LORI CONTIFACILITY TYPE:
730
ADDRESS:5 MARK LANETELEPHONE:
(818) 357-1550
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:3CENSUS: 2DATE:
06/17/2022
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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9
Resident was not administered medication(s) according to physician's instructions while in care.
INVESTIGATION FINDINGS:
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On June 17, 2022, Licensing Program Analyst (LPA), Babatunde Aborchie met with Sails OC Administrator Crystal Garcia to review the complaint investigative findings for the above stated allegations. During the investigation, LPA interviewed two staff, two of two clients (C1 and C2) residing in the facility, Administrator, and reviewed C1 and C2’s medication records.
On February 28, 2022 the Department received allegations that resident was not administered medication(s) according to physician's instructions while in care.
Confidential interview revealed that staff gave an additional dose of medication belonging to C2. Another confidential interview revealed that C1’s medication was administered earlier but C2’s medication was given to C1 in addition. Record review revealed that C2’s medication was given to C1.


.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Babatunde Aborchie
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-CR-20220228113014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SAILS OC CRISIS
FACILITY NUMBER: 306003867
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2022
Section Cited
CCR
84675(c)
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Section 84675(c): Psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in
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The facility immediately ensure that medication provided to C1 is in accordance with written directions of the physician by June 17, 2022.
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 Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 84070(b)(12).
This requirement is not met as evidenced by:
Medication was not used in accordance with written directions of the physician for C1.
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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.
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Babatunde Aborchie
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-CR-20220228113014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SAILS OC CRISIS
FACILITY NUMBER: 306003867
VISIT DATE: 06/17/2022
NARRATIVE
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Based on confidential interviews and record review, the preponderance of evidence standard has been met and the allegation is substantiated. Facility is cited for violation of health-related services Title 22 Group Home Chapter 5, Section 84675(c) Psychotropic medication. Confidential interviews and record reviews confirmed medication was not used in accordance with written directions of the physician prescribing the medication.
A copy of this report was reviewed and provided to Administrator Crystal Garcia, along with the Appeal Rights
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Babatunde Aborchie
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-CR-20220228113014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SAILS OC CRISIS
FACILITY NUMBER: 306003867
VISIT DATE: 06/17/2022
NARRATIVE
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Regarding the allegation that staff are not providing appropriate care and supervision to residents in care, a confidential interview stated that staff were providing appropriate care to C1 and C2 in care. Another confidential interview believed that facility was providing appropriate care for C1 and C2 in care.

Based on confidential interviews, the Department determined there was not sufficient information to determine staff failed to seek medical attention for C1 in a timely manner and staff are not providing appropriate care and supervision to C1 and C2 in care. Although the allegations may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations. The Department’s finding is that these allegations were unsubstantiated.

SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Babatunde Aborchie
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5