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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850084
Report Date: 08/19/2024
Date Signed: 08/19/2024 11:05:46 AM

Document Has Been Signed on 08/19/2024 11:05 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:DEVEREUX CALIFORNIA - TULAROSAFACILITY NUMBER:
425850084
ADMINISTRATOR/
DIRECTOR:		PATTON, CHRISTOPHERFACILITY TYPE:
737
ADDRESS:1855 TULAROSA ROADTELEPHONE:
(805) 879-0357
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 3CENSUS: 3DATE:
08/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:46 AM
MET WITH:Lizeth Aguilar, Assistant SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Miller conducted an unannounced Plan Of Correction (POC) visit to the facility above on 08/19/2024 at 10:46 AM. LPA and met with Lizeth Aguilar and explained the purpose of the visit.

LPA previously visited on 7/1/2024 and cited the Licensee for not ensuring that a separate, complete, and current record is maintained in the facility for each client. POC was due to CCLD on 7/26/2024. The Licensee agreed to update resident files with required documents and email copy of documents to CCLD by POC date. On 7/26/24 CCLD received an email from Christopher Patton, Administrator requesting an extension on his POC due date. An extension was granted to August 9, 2024. To date, the requested documents have not been received.

On 8/19/24, LPA conducted a Plan of Correction visit and issued civil penalties, as a result of not meeting POC due date of 8/9/24. Civil Penalties will continue to accrue at a rate of $100.00 per day, per violation until the deficiency is corrected.

An exit interview was conducted, a copy of the report, Civil Penalties, and appeal rights were printed and delivered.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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