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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801544
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:59:55 AM

Document Has Been Signed on 08/09/2023 10:59 AM - 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:ARC OF VENTURA COUNTY - OXNARD, THEFACILITY NUMBER:
565801544
ADMINISTRATOR:JUAN GARCIAFACILITY TYPE:
775
ADDRESS:416 NORTH "A" STTELEPHONE:
(805) 240-1620
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 90CENSUS: 65DATE:
08/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Juan GarciaTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Teresa Camara conducted a case management - incident visit regarding an incident which took place on 8/4/2023 and was reported to CCL on 8/7/2023. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Katy Robison. LPA and QAS met with administrator Juan Garcia and explained the reason for the visit.

Interviews were conducted with staff at 9:15 a.m., 9:39 a.m., 10:07 a.m. and 10:33 a.m. A client was interviewed at 9:50 a.m.

The incident involved client 1 (C1) and staff 1 (S1). It was reported that S1 made C1 sit in a chair and not get up or move around. During the interviews it was found that C1 is physically capable of getting in and out of a chair on their own. C1's staff redirects C1 for the safety of C1 and other clients as C1 has a history of grabbing others. However, if C1 wishes to walk or move C1 is allowed to do so if it is safe.

The administrator plans on providing training to all staff regarding clients' rights and defining isolation and restraining. Currently C1 has been assigned to different staff.

No deficiencies were observed during the visit. Report issued to administrator.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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