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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801331
Report Date: 12/12/2024
Date Signed: 12/12/2024 05:36:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/02/2024 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20241202104811
FACILITY NAME:STONEHENGEFACILITY NUMBER:
565801331
ADMINISTRATOR:JESUS CARDENASFACILITY TYPE:
735
ADDRESS:1758 SOUTH LEWIS ROADTELEPHONE:
(805) 383-3669
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:15CENSUS: 15DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Jay Lytton, Program DirectorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Insufficient staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 09:14AM. Also present during today's visit was Department of Health Care Services (DHCS) Associate Governmental Program Analyst (AGPA) Kevin Ciacco-Rehkopf. LPA met with Program Administrator Jay Lytton, and various other members of facility and corporate Management. Entrance interview conducted.

During today's visit, LPA interviewed the management team related to staffing, obtained copies of pertinent documents, interviewed staff and clients from 03:20PM to 04:13PM. During an initial complaint visit conducted on 12/03/2024, LPA interviewed Program Administrator, Regional Director of Operations, and Manager beginning at 02:00PM, toured the facility with Program Administrator at 03:54PM and LPA reviewed and obtained copies of pertinent documents. Throughout the course of the investigation, LPA also interviewed various facility staff telephonically and reviewed pertinent documents. The following was then determined: Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20241202104811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: STONEHENGE
FACILITY NUMBER: 565801331
VISIT DATE: 12/12/2024
NARRATIVE
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Record review revealed that the facility's Program Design submitted to the Department indicates "two staff are assigned to work in each casa on each shift." LPA reviewed staff schedules and time cards for the month of November 2024, which revealed that there were a total of 27 8-hour shifts in the month that only 1 staff was scheduled and worked. There were an additional 2 8-hour shifts that did not have any staff scheduled or confirmed worked. Furthermore, on the following shifts, all 4 (four) facilities on the same campus were understaffed according to the facility plan of operation: November 1st on the evening shift there were 4 staff present in total for 4 separate licensed facilities, November 15th on the night shift there were 4 staff present in total for 4 separate licensed facilities, November 22nd on the night shift there were 3 staff present in total for 4 separate licensed facilities, November 23rd on the night shift there were 3 staff present in total for 4 separate licensed facilities, November 29th on the night shift there were 4 staff present in total for 4 separate licensed facilities, and on November 30th on the night shift there were 3 staff present in total for 4 separate licensed facilities. Interview with staff and clients revealed there have been multiple occasions when there was only one staff present and working at a time at this facility. Staff interview also revealed that there have been occasions when staff had to go back and forth between this facility and another on the same physical property during the night shift, as there were no additional staff present, which left clients without supervision. Based on interview and record review, the preponderance of evidence standard has been met, therefore the allegation “insufficient staffing” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D).

Exit interview conducted with facility Management. Today’s reports and appeal rights were reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20241202104811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: STONEHENGE
FACILITY NUMBER: 565801331
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2024
Section Cited
CCR
80022(a)
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80022 Plan of Operation
(a) Each licensee shall have and maintain on file a current, written, definitive plan of operation.
This requirement is not met as evidenced by:
The licensee did not comply with the above
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Facility Management agreed to continue to interview and hire additional staffing, work with the union to provide critical shift bonuses, schedule standby staff, and work with staffing agencies to supplement staffing. Documented staffing progress update will be provided to CCL by POC due date.
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cited section, as program plan indicates 2 staff all shifts, however staff schedules reviewed indicated there were 27 shifts in November which had only 1 staff scheduled/present and 2 shifts with no staff scheduled, which poses a potential health and safety risk to persons 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.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3