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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800884
Report Date: 05/30/2024
Date Signed: 05/30/2024 08:51:52 PM

Document Has Been Signed on 05/30/2024 08:51 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SIMI OAKS COUNSELING GROUPFACILITY NUMBER:
565800884
ADMINISTRATOR/
DIRECTOR:		ERNEST W. FEDERER, PHDFACILITY TYPE:
775
ADDRESS:2345 ERRINGER ST., STE 106TELEPHONE:
(805) 581-4357
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 50CENSUS: 24DATE:
05/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Ernest FedererTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Case Management Deficiency visit in conjunction with complaint visit (CC #29-AS-20231019113617 and 29-AS-20231013151652).

LPA met with Mr. Federer. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaints .

On 11/30/2023, at approximately 4:45 p.m., Community Care Licensing (CCL) Investigations Branch (IB) Investigator Laura Garcia conducted an interview with Staff #1 (S1). During the interview, S1 admitted that they consumed cocaine on the facility premises. S1 admitted to using cocaine while on the premises, however, denied using it in front of clients and during their work hours. Other staff were interviewed and denied using illicit drugs or alcohol while on the facility premises nor did they observe any of the staff using drugs while on the facility premises.



Citation issued, exit interview held, appeal rights given.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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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Document Has Been Signed on 05/30/2024 08:51 PM - It Cannot Be Edited


Created By: Zabel Chochian On 05/30/2024 at 10:56 AM
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: SIMI OAKS COUNSELING GROUP
FACILITY NUMBER: 565800884

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2024
Section Cited
HSC
1569.58(a)2

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H&S1569.58(a)2- Conduct Inimical Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.

This requirement is not met as evidenced by:
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Staff was terminated. Last day worked was 12/22/2023. Licensee/Administrator stated that he is now conducting random unannounsed employee drug tests.

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Based on an interview with Staff #1 (S1), S1 admitted to using cocaine on the facility premises, which posed an immediate health and 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:Desaree Perera
LICENSING EVALUATOR NAME:Zabel Chochian
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024


LIC809 (FAS) - (06/04)
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