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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702356
Report Date: 09/21/2023
Date Signed: 09/21/2023 02:46:09 PM

Document Has Been Signed on 09/21/2023 02:46 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:COTTONWOOD, THEFACILITY NUMBER:
561702356
ADMINISTRATOR:FLORO P CORTES JRFACILITY TYPE:
735
ADDRESS:1417 LIRIO AVENUETELEPHONE:
(805) 647-6046
CITY:SATICOYSTATE: CAZIP CODE:
93004
CAPACITY: 24CENSUS: 23DATE:
09/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Floro CortesTIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Esther Cortez conducted a case management visit to address deficiencies observed during a Ventura County City Inspection. The LPA arrived at the facility at 11:45 a.m. and met with facility staff Marshall Sanjuan and informed them of the reason for the visit. Licensee Floro Cortes arrived shortly.

On 09/11/2023 a NOTICE OF VIOLATION AND NOTICE OF IMPENDING CIVIL ADMINISTRATIVE PENALTIES were issued to the facility by Ventura County's Code Compliance Officer III for the following four (4) violations: Violation 1. Substandard housing conditions: Dilapidated floors (sections of plywood subflooring removed and replaced without permits). Rodent harborage, rodent feces in and around buildings. Several exterior voids/openings in buildings, improperly sealed/screened. Several areas throughout interior of buildings filled in with spray foam insulation to fill voids/prevent access to rodents/insects. Roof leaks at laundry area ceiling were repaired from inside, tarp remains on roof. Improper dryer/appliance venting. Non-permitted, improperly installed water heaters throughout property. Improperly installed, unsafe electrical outlets (missing faceplates, tape covering outlet boxes, other sealers used instead of faceplate. Excessive use of electrical extension cables. Violation 2. Approximately 160 square foot, non-permitted storage building, with non-permitted electrical and air conditioning unit, used for refrigerators and food storage. Violation 3. Non-permitted connection of Unit #1 to Unit #2 with a breezeway. An attached framed roof covering was added between the two structures. Violation 4. Firewood stacked in required setback along rear wall/property line.

During today's visit, the LPA interviewed Licensee Floro Cortez at 12:12 p.m., toured the facility with Licensee at 12:22 p.m., interviewed three (3) clients and took photographs throughout the visit.

Report will continue on LIC809-C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: COTTONWOOD, THE
FACILITY NUMBER: 561702356
VISIT DATE: 09/21/2023
NARRATIVE
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During the facility tour the LPA and licensee observed rodent traps in three bedrooms in buildings 3 and 4, and many holes in facility walls and floors throughout the buildings filled in with spray foam insulation to fill voids/prevent access to rodents. Licensee stated that due to the location where the facility is at, next to an open field, they have a rodent problem and rodents can enter the client rooms if left unopen. However they have a pest control who services the facility on a monthly base to mitigate the issue in addition to setting up traps. Licensee provided the LPA a copy of a recent pest control invoice. All client interviews revealed that rodents are still an issue, and a rodent had been spotted a day prior, however they are able to notify staff and traps are placed.

At 12:38 p.m. the LPA observed a client bathroom in building 2 without a toilet seat. Upon observation, staff stated the client had removed it and the Licensee asked staff to purchase a new toilet seat for the bathroom. The LPA and Licensee also observed dilapidated flooring throughout the facility and unsanitary floors throughout the facility.

The LPA and Licensee observed the non-permitted storage building, with non-permitted electrical and air condition unit, being used as a pantry and also observed the non-permitted connection of Unit#1 to Unit#2 with a breezeway. Lastly the LPA and Licensee observed the stacked wood along the rear wall of the facility. The Licensee stated that they still do not have permits for these two city violations, however they are currently working with a project manager who was hired by Ventura County Behavioral Health to oversee all renovations needed to comply with all violations.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Exit interview and report reviewed with Licensee Floro Cortes. A copy of the report and appeal rights was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/21/2023 02:46 PM - It Cannot Be Edited


Created By: Esther Cortez On 09/21/2023 at 01:40 PM
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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COTTONWOOD, THE
FACILITY NUMBER: 561702356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2023
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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Licensee agrees to do the following:
1. Provide proof of new toilet seat purchased. 2. Provide proof that a Pest control that specializes in rodents will service the facility. 3. Provide proof Licensee is working with the projet manager to oversee all renovations by POC due date.
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Based on interviews and observation, the licensee did not comply with the above cited section, as there is an ongoing rodent problem, a client bathroom was witout a toilet seat, and floors were observed in disrepair which poses an immediate health and safety risk to clients in care.
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Type A
09/25/2023
Section Cited
CCR80086(c)

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Alterations to Existing Buildings and New Facilities.Prior to construction or alterations, state or local law requires that all facilities secure a building permit.

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The Licensee agrees to submit a plan on what they will do to be in compliance with 80086 (c) regulation by POC due date.
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Based on interview and record review the licensee did not comply witht the above cited section, as the city of ventura issued two violations for non-permitted strage builduing and a non-permitted connection of unit #1 to unit#2 with a breezeway which pose an immediate 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:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
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