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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801748
Report Date: 07/06/2023
Date Signed: 07/07/2023 09:32:48 AM

Document Has Been Signed on 07/07/2023 09:32 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:SAILS LA LOMAFACILITY NUMBER:
565801748
ADMINISTRATOR:MARIA LASSITERFACILITY TYPE:
735
ADDRESS:2065 ERBES RDTELEPHONE:
(818) 676-9831
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 4CENSUS: 4DATE:
07/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Joanna IniguezTIME COMPLETED:
02:17 PM
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Licensing Program Analyst (LPA) Sandra Urena and Quality Assurance Specialist (QAS) Liz Aced-Arnett from Tri-Counties Regional Center conducted a subsequent unannounced case management-incident visit and spoke with the District Manager (DM), Joanna Iniguez on the phone. The facility’s administrator was unavailable during the visit. The LPA explained the reason for the visit.
The purpose of today’s visit is to follow up on an incident report received by the Community Care Licensing Division (CCLD) office regarding Resident #1 (R1) Violation of Personal Rights. The LPA interviewed the DM on 06/14/2023 at 11:10 a.m., and staff (S1) at 2:11 p.m. R1 was not available for interview. The LPA interviewed staff (S2) on the phone on 07/06/2023 at 11:05 a.m.

On the allegation that staff threatened residents, to investigate the allegation, the LPA conducted interviews. The interview with S1 revealed that they heard S2 tell R1, ‘If you don’t go to your room, you know what’s going to happen’. The S1 stated that nothing happened after they heard S2 make the statement. Per S1, although other staff were in the facility, no other staff was in the nearby vicinity of the living room area, consequently, no one else heard the statement made by S2. The S1 stated that they did not ask S2 what they meant by the statement, and neither did they ask R1 what that meant. S1 has been working at the facility for a couple of weeks, and this was the first time they hear S2 make a statement like the one made to R1. The LPA interviewed S2 over the phone, and the interview revealed that S2 uses verbal reinforcement to get R1 to ‘calm down’ when R1 is ‘having behaviors’, the behavior being aggressive/combative behavior. Furthermore, S2 stated that the verbal reinforcement goes along with taking away privileges when R1 does not comply, such as ‘being sent to their room’ when R1 is displaying combative behavior with other residents or staff members. According to S2, this type of reinforcement typically gets R1 to comply or to stop the combative behavior. The interview with the administrator revealed that S2 has developed a system to redirect the behavior of R1, when R1 is not compliant with directions. The LPA and the QAS spoke with the DM about providing training to staff on how to use positive reinforcement with all residents/clients.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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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: 07/06/2023
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Based on the information obtained through interviews, there is not sufficient evidence to support the allegation that Resident’s Personal Rights were violated. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted with District Manager Joanna Iniguez over the phone, the facility representative signed the report. Copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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