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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 09:35:40 AM

Document Has Been Signed on 07/07/2023 09:35 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:
02:07 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 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 interview staff (S1), and the DM on 06/14/2023 at 11:10 a.m. The LPA interviewed staff (S1) on the phone on 06/29/2023 at 3:05 p.m. Record review pertaining to the allegation was conducted on 06/14/2023. R1 was not available for interview.

On the allegation that the staff prevented the residents from using the bathroom during the night; the LPA investigated the incident by conducting interviews, and record review. The interview with S1 revealed that they noticed R1 get up at least four times during the night to use the bathroom. The S1 denied preventing R1 from using the bathroom during the night. The bathroom is located across the hallway from the R1’s bedroom and is accessible to R1 when needed. The interview with S2 revealed that R1 has a tendency of using bottles and other containers to urinate, instead of going to the bathroom at night. The administrator stated that R1 has a history of using containers to urinate at night. Record review of daily case notes prepared by staff documented incidents on at least two different dates, when R1 had urinated in the containers and the containers were found in the morning by staff.
Based on the information gathered through interviews and record review, 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
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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