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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801404
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:46:15 PM

Document Has Been Signed on 05/25/2023 01:46 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:SAILS EL CERRITOFACILITY NUMBER:
565801404
ADMINISTRATOR:CRISTINA MARCIAFACILITY TYPE:
735
ADDRESS:187 EL CERRITO CIRTELEPHONE:
(805) 323-7600
CITY:VENTURASTATE: CAZIP CODE:
93002
CAPACITY: 3CENSUS: 3DATE:
05/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Maria LassiterTIME COMPLETED:
01:55 PM
NARRATIVE
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Licensing Program Analysts (LPAs) KaSandra Lopez and Esther Cortez, along with Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnet conducted an unannounced Case Management - Incident inspection at the facility today due to Special Incident Reports (SIRs) received.

When the LPA and QAS arrived at 9:08 AM there were only two staff and three residents present. The Administrator Maria Lassiter was contacted at 9:12 AM and arrived at the home during the visit. The home is vendored by TCRC as a Specialized facility and all three clients in the home require 1:1 supervision between the hours of 6:00 AM and 10:00PM. The Administrator was advised during the visit that a deficiency is being issued today due to insufficient staffing.

The purpose of today's inspection is to follow up on a Special Incident Report (SIR) and Report of Suspected Dependent Adult Abuse Report (SOC341) received on 05/20/2023 pertaining to Client #1 (C1) and Staff #1 (S1). The alleged incidents occurred on 04/11/2023 and on approximately 04/17/2023. During today inspection, interviews were conducted with Staff #2 (S2) at 9:20 AM and the Administrator at 10:23 AM. S1 is currently on administrative leave. Record review was conducted and copies of pertinent records were requested. It was discussed with the Administrator that the SOC 341 completed was not cross reported to law enforcement. The Administrator agreed to cross report today. C1 arrived at the end of the visit from an outing and was interviewed at 1:41 PM. The LPAs have determined further investigation is needed and will return at a later date to continue the investigation.

During today's inspection, the LPAs and QAS were advised that Staff #3 (S3) was also on administrative leave due alleged abuse between S3 and Client #3 (C3) which occurred on 05/21/2023. Community Care Licensing received the incident report today while the LPAs were in the field. During today's visit an interview was conducted with Client #3 at 12:20 PM. Record review was conducted and copies of pertinent records were requested. The LPAs have determined further investigation is needed and will return at a later date to continue the investigation.
Exit interview conducted. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). A copy of the report and appeal rights was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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Document Has Been Signed on 05/25/2023 01:46 PM - It Cannot Be Edited


Created By: Kasandra Lopez On 05/25/2023 at 12:51 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: SAILS EL CERRITO
FACILITY NUMBER: 565801404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2023
Section Cited
CCR
80065(a)

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80065 Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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The Administrator shall submit proof of sufficient staffing and an updated staff schedule to CCL by 05/26/2023.
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Based on observation and interviews, the licensee did not comply with the section cited above as the facility was not staffed sufficiently as three clients require 1:1 support during awake hours and only two staff were present which poses an immediate 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.
SUPERVISOR'S NAME:Desaree Perera
LICENSING EVALUATOR NAME:Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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