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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801544
Report Date: 02/25/2025
Date Signed: 02/25/2025 12:45:16 PM

Document Has Been Signed on 02/25/2025 12:45 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:ARC OF VENTURA COUNTY - OXNARD, THEFACILITY NUMBER:
565801544
ADMINISTRATOR/
DIRECTOR:		JUAN GARCIAFACILITY TYPE:
775
ADDRESS:416 NORTH "A" STTELEPHONE:
(805) 240-1620
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 90CENSUS: 64DATE:
02/25/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Juan Garcia TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Esther Cortez conducted a case management visit at the Day Program (DP) regarding a self-reported incident that occurred on 02/14/2025. LPA met with Administrator Juan Garcia and explained the reason for the visit.

It was reported that on 02/14/2025, Client 1 (C1) was choking on a meatball sandwich provided by the DP, received Heimlich maneuver from staff, and C1 was successful in coughing up a meatball. It was further reported that C1 got their plate of food before staff could cut up their meal.

During today's visit the LPA conducted two (2) staff interviews and a file review. Staff Interviews revealed that C1 has chocking hazard and food needs to be chopped up prior to being provided. On 02/14/25, C1 was assigned to Staff 1 (S1) and was provided food by another staff while S1 was on lunch. S1 returned from lunch, started passing out napkins to the clients and notice C1 was displaying signs of choking and started doing abdominal thrusts on C1. S1 asked a coworker to get assistance and another staff came and started doing abdominal thrusts on C1, then C1 was able to cough up a meatball. S1 is not aware if the other staff that provided the food knew that C1 needed their food to be cut up. S1 also revealed that C1 brings their lunch from home, which is chopped up, and the DP only provides meals on certain occasions, has not cut up C1's meals prior to this incident, and has seen C1 eat things at the DP without being cut up, like pizza.
File Review revealed that C1 has a Heart Healthy diet with Mechanical Soft (no hard edges) consistency that should be served in portions per their Physicians report dated 12/24/2024. Furthermore, a review of C1's Emergency Information Printout on file revealed that the DP's dietary concerns for C1 are that C1 has a history of constipation and very slow eater and that all foods must be chopped/pureed before getting near C1's space.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit (See 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 02/25/2025 12:45 PM - It Cannot Be Edited


Created By: Esther Cortez On 02/25/2025 at 12:09 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: ARC OF VENTURA COUNTY - OXNARD, THE
FACILITY NUMBER: 565801544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2025
Section Cited
CCR
80076(6)(A)

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Food Services
(6) Modified diets prescribed by a client's physician...(A)The licensee shall obtain and follow instructions from the physician or dietitian on the preparation of the modified diet. This requirement was not met as evidenced by:
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Administrator agrees all staff will receive special dietary needs training and will conduct quarterly trainings on face sheets, physician’s orders, and diets. Proof of training and a commitment stating these items will take place on an on-going basis will be submitted by POC due date.
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Based on interviews and record review, C1 has a mechamcal soft diet that needs to be chopped/pureed and was given a meatball sandwhich by staff without being cut up which C1 choked on and coughed up which posed an immidiate health and safety hazard to clients 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:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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