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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801271
Report Date: 05/21/2024
Date Signed: 05/21/2024 03:42:25 PM

Document Has Been Signed on 05/21/2024 03:42 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:VOCATIONAL SKILLS SERVICES, INC.-ADP/OXNARDFACILITY NUMBER:
565801271
ADMINISTRATOR/
DIRECTOR:		LAILANI G. MACASIASFACILITY TYPE:
775
ADDRESS:549 WEST HUENEME ROADTELEPHONE:
(805) 986-8300
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 36CENSUS: 15DATE:
05/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Lailani G. MacasiasTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with staff and explained the reason for the visit. Administrator Lailani Macasias arrived shortly thereafter.

The reason for today's inspection is to follow up on a self-reported incident report received on 05/16/2024. The report pertains to an incident involving Client#1 (C1). It was reported that on 5/15/24, C1 approached staff saying they were having a headache, and after a few minutes C1 started throwing up. It was further reported that C1 became unresponsive and was sent to the hospital. C1 passed away on 5/16/24 at the hospital due to a brain bleed. Per the information received, the circumstances surrounding the death of Client #1 on 05/16/2024 may be questionable and needs to be investigated.

During today's visit, the LPA conducted an interview with the administrator throughout the visit, a brief tour of the facility and obtained copies of pertinent documents.

This incident was referred to Community Care Licensing Investigations Branch (IB) for review. Further investigation is required. An investigator or the LPA will return at a later date.

Exit interview conducted. A copy of the report was issued to the Administrator Lailani.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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