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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801817
Report Date: 10/10/2024
Date Signed: 10/10/2024 03:46:10 PM

Document Has Been Signed on 10/10/2024 03:46 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:CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISESFACILITY NUMBER:
565801817
ADMINISTRATOR/
DIRECTOR:		JUDITH FLICKNERFACILITY TYPE:
775
ADDRESS:2041 CABOT PLACETELEPHONE:
(805) 988-6508
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 60CENSUS: 32DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Patrice Aaron-Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analysts (LPA's) Esther Cortez and Erica Mosley arrived at the Adult Day Program (ADP) unannounced to conduct a required annual visit at 9:40 a.m. The LPA's met with Assistant Director Patrice Aaron and explained the reason for the visit. Upon arrival, there were thirty-two (32) consumers and thirteen (13) staff in the building. The program currently operates from 8:00 a.m. to 2:00 p.m. The day program was staffed with 1:3 staff to consumer ratios. The owner, Mathew Steinorth arrived during the visit and the visit was explained.

At 9:57 a.m., the LPA's and the Assistant Administrator toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Cleaning supplies are stored in a locked supply closet.

RESTROOMS: There are four (4) total bathrooms at the facility. One (1) is designated as a shower bathroom. The bathrooms have grab bars and were clean and sanitary. The hot water temperature in two of the restrooms, one (1) on each floor were tested at 10:00 a.m., and, 10:10 a.m. and measured at 114.2 degrees Fahrenheit and at 115.2 degrees Fahrenheit.

COMMON SPACES/ACTIVITY SPACE: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was
observed to be in good condition. LPA's observed the required postings in the common hallway. The fire extinguishers were last serviced on 1/24/2024 and there is an upcoming fire panel inspection by Boyd & Associates scheduled for 10/16/2024. .

Activities: Activities are both designed for individual and as a group. Activity supplies were observed in the large activity room.
Report will continue on LIC 809-C 2nd page.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISES
FACILITY NUMBER: 565801817
VISIT DATE: 10/10/2024
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Medication Audit: A medication audit for four (4) clients was conducted at 12:10 p.m. and the
following was observed. The medications were stored in a locked medication cart, inside a locked medication room and inaccessible to the clients. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record.

KITCHEN: Kitchen knives are stored in the locked cabinet in the administrator's office. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. Clients bring their own lunches. Snacks are offered to clients in the morning. There are no pesticides or toxins stored in any food storage or preparation area with utensils. Cabon monoxide in the kitchen area was tested and operable.

INFECTION CONTROL: The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate.

Record Review: A review of facility files was conducted at 11:07 a.m. The LPA's observed documentation of Infection Control, Disaster prevention, and Insurance liability. The LPA's obtained Client Roster, Staff Roster, and Insurance Liability. The LPA's reviewed six (6) of thirty-two (32) Client Files, and six (6) of thirteen (13) staff files. LPA Cortez observed fifteen (15) clients with postural supports, however no approved postural support exceptions letters were observed for any of the 15 clients. Otherwise, all resident and staff documents reviewed appeared complete and current.

Interviews: During today's visit, starting at 10:17 a.m. the LPA's interviewed six (6) staff and six (6) consumers. No immediate concerns voiced at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to the Assistant Director and Owner.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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Document Has Been Signed on 10/10/2024 03:46 PM - It Cannot Be Edited


Created By: Esther Cortez On 10/10/2024 at 03:14 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: CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISES
FACILITY NUMBER: 565801817

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82072(a)(8)
Personal Rights
(a) Each client shall have personal rights which include, but are not limited to, the following: (8) Not to be placed in any restraining device. Postural supports may be used under the following conditions:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and interview the licensee did not comply with the section cited above in fifteen (15) clients that were observed with seatbelts and/or H-straps harnesses without an approved exception request from licensing which poses a potential health and safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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Assistant Administrator and Owner agreed to submit exception request for postural supports to licensing for the fifteen (15) clients, no later than the 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:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024


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