<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801423
Report Date: 12/12/2024
Date Signed: 12/12/2024 05:32:03 PM

Document Has Been Signed on 12/12/2024 05:32 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:HOUSE OF TRANSITIONFACILITY NUMBER:
565801423
ADMINISTRATOR/
DIRECTOR:		JESUS CARDENAS AMADORFACILITY TYPE:
772
ADDRESS:1750C SOUTH LEWIS ROADTELEPHONE:
(805) 437-2903
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 15CENSUS: 12DATE:
12/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Jay Lytton, Program AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:45 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
LPA conducted a case management – deficiencies visit at the facility today in conjunction with unrelated complaint visits conducted at other facilities on the same physical grounds. 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 at 09:14AM. Entrance interview conducted.

Record review revealed that the facility's Program Design submitted to the Department indicates "one residential counselor is scheduled for the Casa on the day shift and two Residential Recovery Counselors are scheduled on the evening and night shift seven days a week.” LPA reviewed staff schedules and timecards for the month of November 2024, which revealed that there were a total of 15 evening and night shifts in the month that only 1 Residential Counselor staff was scheduled and worked. There were an additional 2 evening and night shifts did not have any Residential Counselor staff scheduled or confirmed worked. 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. 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.

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 and corporate 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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/12/2024 05:32 PM - It Cannot Be Edited


Created By: Kelly Dulek On 12/12/2024 at 04:37 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: HOUSE OF TRANSITION
FACILITY NUMBER: 565801423

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
81022(a)

1
2
3
4
5
6
7
81022 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
1
2
3
4
5
6
7
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.
8
9
10
11
12
13
14
cited section, as program plan indicates 2 staff on evening and night shifts, however staff schedules reviewed indicated there were 15 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.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: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


LIC809 (FAS) - (06/04)
Page: 2 of 2