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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800366
Report Date: 06/05/2020
Date Signed: 06/05/2020 05:08:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117
FACILITY NAME:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:SARAH DODDFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: DATE:
06/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Sarah DoddTIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Other inspection to deliver an Immediate Exclusion Order pertaining to Staff #1 (S1) . Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s inspection was conducted via video call with Sarah Dodd, the facility administrator.

It was determined by the Department that a complaint of conduct inimical was substantiated against Staff #1 (S1), thus, necessitating the Order for Immediate Exclusion from the facility. During today’s visit, an “Order To Licensee/Facility Of Immediate Exclusion From All Facilities” was issued which will be emailed to Ms. Dodd immediately after the inspection is concluded. The LPA reviewed the Order with Ms. Dodd. Ms. Dodd stated S1 has not began employment at the facility and understands S1 cannot work at the facility. The LPA requested pertinent documents to be faxed or emailed to the LPA.

A telephonic exit was conducted with Ms. Dodd. A copy of today's report for signature and the Order for Immediate Exclusion from the facility will be provided via email to Ms. Dodd.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020
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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