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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802405
Report Date: 06/07/2023
Date Signed: 06/13/2023 10:06:04 AM

Document Has Been Signed on 06/13/2023 10:06 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 50/50FACILITY NUMBER:
565802405
ADMINISTRATOR:ROOS, MARCHELINOFACILITY TYPE:
735
ADDRESS:1071 BALSAMO AVETELEPHONE:
(760) 631-7550
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 4CENSUS: 2DATE:
06/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:22 PM
MET WITH:Marchelino RoosTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Teresa Camara conducted a case management-deficiencies visit while at the facility conducting a subsequent complaint visit regarding complaint control number 29-AS-20220719114352. During the complaint investigation, a deficiency unrelated to the complaint allegations was observed. LPA explained the reason for this report to administrator Marchelino Roos.

Tri-Counties Regional Center (TCRC) Quality Assurance Manager (QAM) Freddie Garcia stated the staffing requirements for this facility during awake hours, as per their contractual agreement with TCRC, are as follows:

This facility has two crisis placement beds. Clients in the crisis beds require one-to-one staffing during awake hours. This facility has two regular placement beds as well. Those two clients require a minimum of one staff during awake hours. Therefore, if the facility has two regular placement clients and two crisis placement clients they should have a minimum of three staff working.

Staff schedules for 6/19/22, 7/10/22, 7/19/22 and 9/15/22 show there were not enough staff during awake hours. On 9/15/22 the QAM observed three clients at the facility but only one staff was working between 1:00 p.m. – 2:30 p.m. A second staff arrived later, however at that time, based on the clients being served, the facility should have had three staff working.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited
(refer to LIC 809-D).

Exit interview conducted. Copy of the report and appeal rights given to administrator via email.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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Document Has Been Signed on 06/13/2023 10:06 AM - It Cannot Be Edited


Created By: Teresa Camara On 06/07/2023 at 02:44 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 50/50
FACILITY NUMBER: 565802405

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2023
Section Cited
CCR
85065.5

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85065.5 Day Staff-Client Ratio (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met: (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients.
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Administrator has stopped taking in new clients until he is able to hire an appropriate number of staff. Administrator provided current schedules which show proper staffing at this time.
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This requirement is not met as
evidenced by: Based on observation and records, the licensse did not comply with the section cited above as there were not enough staff working to meet TCRC staffing requirements, which poses a potential heatlh, safety and personal right risk to persons 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:Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME:Teresa Camara
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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