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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800303
Report Date: 02/26/2025
Date Signed: 02/26/2025 04:00:10 PM

Document Has Been Signed on 02/26/2025 04:00 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:COLE VOCATIONAL SERVICES AUTO CENTERFACILITY NUMBER:
565800303
ADMINISTRATOR/
DIRECTOR:		LISA LOPEZFACILITY TYPE:
775
ADDRESS:2011 AUTO CENTER DR STES 106-7TELEPHONE:
(805) 278-2700
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 60CENSUS: 33DATE:
02/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Janica Destrampe Supervisor/ Leah KolbeckTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Esther Cortez conducted a case management visit at the Day Program (DP) regarding two self-reported incidents that occurred on 02/10/2025 and 02/21/2025. The LPA met with the DP's supervisor Jinica Destrampe and explained the reason for the visit. At the time the LPA arrived the clients were leaving the DP for the day. Area Director Leah Kolbeck was present during today's visit as well.

It was reported that on 02/10/2025, Staff 1 (S1) lost Client 1's (C1) back pack with their Medication Administration Record (MAR), which contains C1's name, gender, birth date, medications, physician's name and pharmacy name.
It was also reported that on 02/21/2025, Client 2 (C2) was picked up early at 11:30 a.m. due to having a terrible cough. When C2 got picked up, their family member realized they needed changing and went back inside to change the client. DP's Supervisor assisted in changing C2. Family member mentioned to Supervisor that C2's skin is easily irritated and both of them observed a small irritated spot on C2. C2's Staff 2 (S2) for that day was informed C2 needed to be changed, and S2 apologized for their oversight.

During today's visit the LPA conducted two (2) staff interviews and a file review. Interview with S1 revealed that they lost C1's personal back pack with their MAR. Interview with the DP's supervisor revealed that S2 is not a regular staff, did not read C2's file and therefore was not aware that C2 needed to be changed as part of their care needs. Furthermore, C2 went from 8:30 a.m. to 11:30 a.m. without being changed. File review revealed that C2 needs to be toileted when they get to the DP, after lunch and before they get on the bus and that they have very sensitive skin and will break out in a rash if they are not changed properly. Furthermore, File review revealed that S2 is not associated to the DP. S2 got associated during the visit.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited during the visit (See 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 02/26/2025 04:00 PM - It Cannot Be Edited


Created By: Esther Cortez On 02/26/2025 at 02:55 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: COLE VOCATIONAL SERVICES AUTO CENTER
FACILITY NUMBER: 565800303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2025
Section Cited
CCR
82070(c)(1)

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82070 Client Records, (c)All information and records obtained from or regarding clients shall be confidential. (1)The licensee shall be responsible for safeguarding the confidentiality of client records contents. This requirement was not met as evidenced by:
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POC Cleared. Staff have already received training.
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Based on interviews and record review the licensee failed to safegurd C1's personal backpack wich contained their MAR as staff lost C1's back pack which poses a potential safety or personal rights risk to C1 in care.
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Type B
03/07/2025
Section Cited
CCR82078

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82078 Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. This requirement was not met as evidenced by:
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Supervisor agreed all staff will receive training on regarding care and supervision and reading clients profiles prior to assisting clients. The administrator will submit proof all staff received this training. by 03/07/25
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Based on interview and record review, the licensee failed to ensure care was provided to C2 as they went the whole time at DP without being changed which resulted in irritation which poses a potential health and safety risk to clients 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: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 02/26/2025 04:00 PM - It Cannot Be Edited


Created By: Esther Cortez On 02/26/2025 at 03:37 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: COLE VOCATIONAL SERVICES AUTO CENTER
FACILITY NUMBER: 565800303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2025
Section Cited
CCR
80019(e)(3)

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80019(e)(3) Criminal Record Clearance: All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance...This requirement is not met as evidenced by
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POC Cleared. S2 was associated to the facility during the visit.

A $100 civil penalty was issued today.
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Based on record review, the licensee did not comply with the section cited above as staff 2 (S2) is not associated to the facility which poses an immediate health and safety 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:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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