<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800551
Report Date: 02/08/2024
Date Signed: 02/08/2024 12:42:24 PM


Document Has Been Signed on 02/08/2024 12:42 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:GABLES OF OJAI, THEFACILITY NUMBER:
565800551
ADMINISTRATOR:MATTEO DIGRIGOLIFACILITY TYPE:
740
ADDRESS:701 N. MONTGOMERY ST.TELEPHONE:
(805) 646-1446
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:118CENSUS: 82DATE:
02/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Matteo DigrigoliTIME COMPLETED:
12:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Esther Cortez conducted a Case Management-deficiencies visit to address deficiencies noted during Complaint Control #29-AS-20240201103428 investigation visit conducted on 2/08/2024. LPA met with Administrator Matteo Digrigoli and explained the purpose of the visit.

During today’s visit, LPA obtained a copy of hospital discharge summary notes for resident #1 who sustained a fracture rib on November 10, 2023. LPA reviewed facility files for notification from the facility of Unusual/Serious Incident Report (SIR) for R1. As of today’s visit, no Unusual/Serious Incident Report (SIR) have been received by CCL for R1's fractured rib. LPA requested an SIR to be submitted for R1's incident. LPA reviewed R1's file and noted several incident reports for R1 have not submitted to CCL.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to 809-D).


Exit interview conducted, deficiencies cited, and the report and appeal rights issued during today’s visit
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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 2


Document Has Been Signed on 02/08/2024 12:42 PM - 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: GABLES OF OJAI, THE
FACILITY NUMBER: 565800551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
CCR
87211(a)(1)

1
2
3
4
5
6
7
87211 (a)(1) Reporting Requirements. A written report shall be submitted to the licensing agency and to person responsible within seven days of the occurrence of any of the events specified in (A) through (D) below...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Incident report for R1 was submitted during todays visit. Administrator agreed to submit a plan to ensure written reports will be submitted to CCL within 7 days and submit plan to LPA by 2/16/23.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above when the facility did not submit incident reports within 7 days, which posed a potential health and safety risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2