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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801748
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:29:41 PM

Document Has Been Signed on 02/26/2024 01:29 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 LA LOMAFACILITY NUMBER:
565801748
ADMINISTRATOR:JAMIE CHAVEZ CALLEJASFACILITY TYPE:
735
ADDRESS:2065 ERBES RDTELEPHONE:
(805) 864-3733
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 4CENSUS: 4DATE:
02/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jamie Chavez CallejasTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Martha Arroyo and Valeria Conway arrived at the facility unannounced for a required one-year annual inspection today. The last annual conducted at this facility was on 12/10/2022. When the LPAs arrived, there were two (2) staff and two (2) clients present. The LPAs were greeted at the door by the House Lead, Eldy Carcamo and at this time, the reason for the visit was explained. The Administrator, Jaime Chavez Callejas arrived at approximately 10:31 a.m. Entrance interview conducted.

At 9:43 a.m., the LPAs along with the House Lead toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: The LPAs inspected the kitchen/food service area at 9:55 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Staff arrived with additional groceries during the inspection. Refrigerator and dry food pantry were checked for proper labels and expiration dates and food labels had expiration date clearly marked. Knives and sharps were observed locked and inaccessible in the hallway closet. At 9:58 a.m., the hot water temperature was measured in the kitchen sink and it measured 106.7 degrees Fahrenheit.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 10:06 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit.

Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAILS LA LOMA
FACILITY NUMBER: 565801748
VISIT DATE: 02/26/2024
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Continued from LIC 809...

The fire extinguishers were observed to be in compliance and last charged on 01/18/2024. The LPAs observed required postings throughout the common space. There is a working telephone on premises. Auditory alarms were functioning at the time of the visit. An adequate supply of emergency food and water was observed at the time of the visit. LPAs observed cameras in common areas.

GARAGE: The garage is attached to the facility. There is one (1) additional refrigerator with perishable items in good condition. The LPA observed a sufficient supply of Personal Protection Equipment (PPE).

LAUNDRY ROOM: There is a washer and dryer on premises. The staff assist clients with all laundry needs. The LPAs observed detergents and cleaning supplies in a locked cabinet inaccessible to clients in care.

BACKYARD: The backyard has an area equipped with furniture for client use. At 10:01 a.m., the LPAs observed a large amount of wood with large nails sticking out in the backyard. The Administrator contacted a person to haul away wood as soon as possible. Emergency exits and passageways were observed free of obstruction. The facility has one (1) side gate that self-latches. No bodies of water noted at the time of the visit.

BEDROOMS: There are four (4) client bedrooms. The LPA observed the client bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: There are three (3) client restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with liquid hand soap and paper towels; towels and washcloths are not shared. Hand washing signs were observed in the bathrooms. The hot water temperature was measured in all three (3) bathrooms between 9:43 a.m. and 9:53 a.m. and were found in compliance measuring between 107.7 and 109. 2 degrees Fahrenheit.

Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAILS LA LOMA
FACILITY NUMBER: 565801748
VISIT DATE: 02/26/2024
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Continued from LIC 809C...

RECORDS: Records review began at 10:26 a.m.; four (4) client records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were complete.

Three (3) personnel records including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were complete.

The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 4-i home.

The last emergency disaster drill took place on 02/21/2024.

MEDICATIONS: Medications review began at approximately 12:10 p.m.; medications are centrally stored in a locked closet by the hallway. All medications including PRNs were labeled, stored, and locked inaccessible to clients. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct this deficiency may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/26/2024 01:29 PM - It Cannot Be Edited


Created By: Martha Arroyo On 02/26/2024 at 01:01 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 LA LOMA
FACILITY NUMBER: 565801748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observations, the licensee did not comply with the section cited above as broken wood with large nails were in the backyad at the time of the inspection, which poses a potential safety risk to persons in care.
POC Due Date: 02/27/2024
Plan of Correction
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The Administrator contacted a person during the inspection to have wood removed from premises.
The Administrator will send pictures to CCL showing wood has been hauled away and no longer in the backyard no later than POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Martha Arroyo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


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