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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700160
Report Date: 09/21/2022
Date Signed: 10/05/2022 10:08:44 AM


Document Has Been Signed on 10/05/2022 10:08 AM - 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:CASA DORINDAFACILITY NUMBER:
421700160
ADMINISTRATOR:BRIAN MCCAGUEFACILITY TYPE:
741
ADDRESS:300 HOT SPRINGS RD.TELEPHONE:
(805) 969-8011
CITY:SANTA BARBARASTATE: CAZIP CODE:
93108
CAPACITY:325CENSUS: 348DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Brian McGague, AdministratorTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kristin Kontilis made an unannounced case management visit to the facility to follow up on a confirmation of removal notification for one staff, and review fingerprint clearance. Administrator Brian McCague arrived at approximately 1:35 pm. LPA met with Administrator and explained the purpose for the visit.
A Decision and Order regarding Staff 1’s (S1's) exclusion from the facility was effective 9/16/2022. Documents were served to S1 and the Licensee on 9/6/2022. In an email dated 9/6/2022, Administrator Brian McCague confirmed S1 was hired on 5/24/2021 and would be terminated as of 9/6/2022. LPA verified S1 was disassociated from the facility’s fingerprint roster. During this visit, LPA obtained a staff roster/schedule and confirmed S1 was not present. Administrator McCague provided termination documentation to LPA to verify S1 was terminated effective 9/6/2022. Based on the evidence obtained during today's visit, the LPA has verified that Individual S1 is not present, employed, or residing at the facility. Verification of removal is complete.
LPA observed on the staff roster dated 9/8/2022, ten (10) additional staff did not have fingerprint clearance to work in the facility. In an email dated 9/8/2022, Administrator Brian McCague confirmed three (3) of the staff with pending clearance were still pending and were working in the facility. LPA confirmed through interview and documentation that four (4) staff (S2, S3, S4, S5) were working in the facility prior to receiving fingerprint clearance including S1. On 9/8/2022, Administrator stated in an email, he thought S5 had DOJ clearance and was cleared to work.
Administrator Brian McCague stated he thought PIN 20-09-CCLD was still in effect. PIN 20-09-CCLD waived fingerprint clearance requirements during the COVID-19 lockdowns in 2020. However, the fingerprint clearance requirement was reinstated on 7/6/2020 in PIN 20-24-ASC, which states on Page 1 that “background check waivers…are not being extended.”
Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 809-D), and civil penalties are issued. Exit interview conducted. Copy of report and appeal rights issued via email.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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Document Has Been Signed on 10/05/2022 10:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: CASA DORINDA
FACILITY NUMBER: 421700160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/21/2022
Section Cited

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87355(e)(1) CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department…
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On 9/8/2022, Administrator submitted a written statement that S1 was terminated; S2 was removed from the schedule. Administrator agrees that staff will not work until they are cleared.
POC cleared during visit.
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This requirement was not met as evidenced by: Based on record review and interview, the licensee did not comply with the above cited section in 5 of 5 staff (S1-S5) worked in the facility prior to obtaining fingerprint clearance, which posed an immediate health and safety risk to 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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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