565801271-7-3-2023-29-AS-ECOZ-CTE2AD-20230703171323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801271
Report Date: 07/03/2023
Date Signed: 07/03/2023 05:14:36 PM

Document Has Been Signed on 07/03/2023 05:14 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VOCATIONAL SKILLS SERVICES, INC.-ADP/OXNARD		FACILITY NUMBER:	565801271
ADMINISTRATOR:	LAILANI G. MACASIAS		FACILITY TYPE:	775
ADDRESS:	549 WEST HUENEME ROAD		TELEPHONE:	(805) 986-8300
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 36		CENSUS: 22	DATE:	07/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lailani G. Macasias		TIME COMPLETED:	05:15 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 arrived at the Adult Day Program (ADP) unannounced to conduct a required annual visit at 9:00 a.m. The LPA met with Administrator Lailani Macasias and explained the reason for the visit. Upon arrival, there were fifteen (15) consumers and eight (8) staff in the building. The program currently operates from 8:00 a.m. to 3:00 p.m. The day program was staffed with 1:3 staff to consumer ratios. Temperatures of staff, consumers and visitors are taken upon entry into the facility. At 9:05 a.m., the LPA and the Administrator Lailani toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The smoke alarms and carbon monoxide detectors were tested throughout the tour and were operational. Cleaning supplies are stored in a locked area. PPE supplies are stored in a locked office. Common Activity Space: The facility is a single-story structure with one large activity room, one conference room, three offices, two bathrooms, a quiet/sick room, and a food service area. The LPA did not observe any obstructions or hazards during the inspection. The program site appeared to be clean, safe, sanitary, and in good repair at this time. The LPA observed fire extinguishers throughout the facility, which were last serviced 06/7/2023. Activities: Activities are both designed for individual and as a group. Activity supplies were observed in the large activity room. Food Service: The kitchen areas were clean and in good condition. Consumers bring their lunch and snacks. The facility has emergency food supplies and snacks available for consumers. Restrooms: The two restrooms were observed to be clean and sanitary with a hand soap and paper towels. The hot water temperature in the restroom was tested at 10:01 a.m., and it measured at 117.0 degrees Fahrenheit. Report will continue on LIC809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VOCATIONAL SKILLS SERVICES, INC.-ADP/OXNARD	FACILITY NUMBER: 565801271
	VISIT DATE: 07/03/2023

NARRATIVE

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Record Review: At 10:35 a.m. a review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention, and Insurance liability. The LPA obtained Client Roster, Staff Roster, and Staff schedule. At 11:35 a.m., the LPA reviewed five (5) of twenty-two (22) Client Files. At 2:00 p.m. the LPA reviewed five (5) of eleven (11) staff files. All resident and staff documents reviewed appeared complete and current.

Infection Control: There was a central entry point for symptom screening and temperature checks. Facility has a sufficient supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol was sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility's procedures as it pertains to infection control are adequate.

Interview: During today's visit, at 2:45 p.m. the LPA interviewed three (3) staff and three (3) consumers. No immediate concerns voiced at this time.

Medication Audit: A medication audit for three (3) clients was initiated at 3:10 p.m. and the

following was observed. The medications were stored in a locked cabinet inside a locked office. and
inaccessible to the clients. During Client #1 (C#1's) audit, the LPA observed Gabapentin not properly
documented on the centrally stored medication and destruction log (CSMDR), as the Rx and quantity number did not match the prescription label. During C#2's audit, the LPA observed Lorazepam not properly documented on the CSMDR, as the Rx number did not match the prescription label. During C#3's audit, the LPA observed Calcium 600 + D not properly documented on the CSMDR, as the Rx and quantity number did not match the prescription label. . Administrator documented the correct Rx and quantity number upon observation.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted and copy of the report and appeal rights provided to Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/03/2023 05:14 PM - It Cannot Be Edited

Created By: Esther Cortez On 07/03/2023 at 04:44 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: VOCATIONAL SKILLS SERVICES, INC.-ADP/OXNARD	FACILITY NUMBER: 565801271
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82075(l)

Health-Related Services

(l) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, and record review, the licensee did not comply with the section cited above in three out of three medications as medications were not properly documented on the centrally stored medication and destruction log, the Rx and quantity number did not match the prescription label which poses a potential health & safety risk to persons in care.
	POC Due Date: 07/24/2023
	Plan of Correction
1 2 3 4	Administrator stated that staff was copying the old prescription number on the CSMDR rather than inputting current Rx number. Administrator documented the correct Rx and quantity number upon observation on all three medications, & will have medication record keeping training for all staff and submit proof to CCL no later than the end of day on POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Esther Cortez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC809 (FAS) - (06/04)

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