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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801271
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:06:06 PM

Document Has Been Signed on 07/10/2024 01:06 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: 14DATE:
07/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Lailani G. MacasiasTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Esther Cortez arrived at the Adult Day Program (ADP) unannounced to conduct a required annual visit at 10:30 a.m. The LPA met with Administrator Lailani Macasias and explained the reason for the visit. Upon arrival, there were fourteen (14) consumers and five (5) 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 10:45 a.m., the LPA and the Administrator 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 06/4/2024 and 06/05/2024.
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 11:28 a.m., and it measured at 108.7 degrees Fahrenheit.

Report will continue on LIC809-C
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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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: VOCATIONAL SKILLS SERVICES, INC.-ADP/OXNARD
FACILITY NUMBER: 565801271
VISIT DATE: 07/10/2024
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Record Review: At 11:35 a.m. a review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention, and last disaster drill conducted on 06/03/2024. The LPA obtained Client Roster, Staff Roster, and Staff schedule. The LPA reviewed five (5) of fourteen (14) Client Files and the LPA reviewed five (5) of ten (10) 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,. the LPA interviewed one (1) staff and four (4) consumers. No immediate concerns voiced at this time.

Medication Audit: A medication audit for three (3) clients was initiated at 12:30 p.m. and the


following was observed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. The were no errors observed. First aid kit was observed to be complete.

No deficiencies were issued. Exit interview conducted and copy of the report provided to Administrator.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
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