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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609703
Report Date: 04/21/2025
Date Signed: 04/21/2025 05:30:28 PM

Document Has Been Signed on 04/21/2025 05:30 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:REESEJOY CARE HOMEFACILITY NUMBER:
567609703
ADMINISTRATOR/
DIRECTOR:		DELA VEGA RAMIREZ, ROBERTOFACILITY TYPE:
740
ADDRESS:1355 JUANITA AVETELEPHONE:
(805) 278-4043
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
04/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Roberto Dela VegaTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced Case Management -Incident visit, The purpose of the visit is to follow up on an elopement Incident reported to the LPA on 04/15/25. The LPA met with staff and the reason for the visit was explained. Administrator Roberto Dela Vega arrived at 4:05 p.m.

It was reported that on 04/11/2025, at approximately 4:00 a.m. when facility staff was getting ready to prepare breakfast and clean up they found out that Resident #1 (R1) was not in their bed. Staff searched for R1 and could not find them, they reported to the Administrator and police. Police notified the Administrator that the resident had been found and was at St. John's hospital. The Administrator brought R1 back to the home around 5:30 a.m.

On 04/18/25, the LPA conducted a phone interview with Administrator Roberto and requested hospital discharge documents. During the phone call, the Administrator revealed that R1 had sustained a bruise in the left eyebrow. On 04/20/25, the LPA received R1's hospital discharge documents, and a photo of R1's face. Discharge documents revealed that R1 had sustained a fall, and discharge diagnosis were listed as" closed head injury, nasal bone fracture and facial laceration. Photo of R1 showed R1's face, with a stitched laceration above their left eye, and yellow and purple discoloration around both cheek bones.

During today's visit the LPA interviewed R1, two staff and the administrator. R1 was not able to fully explain what happened to them, however they revealed they feel safe at the home. Both staff revealed that R1, had exhibited wandering and elopement behaviors prior to R1's elopement. Report will continue on LIC809-C, 2nd page.
Kasandra LopezTELEPHONE: (818) 596-4343
Esther CortezTELEPHONE: (747) 230-2225
DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: REESEJOY CARE HOME
FACILITY NUMBER: 567609703
VISIT DATE: 04/21/2025
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Staff further revealed that R1's prior roommate had stated to the police they went to the restroom at 1:00 a.m. and they did not see R1 in the room. Staff also revealed that even though they have auditory alarms on the doors, they cannot hear them when they are in a deep sleep and the last time they checked on R1 was at 10:30 p.m. Hospital records indicate that R1 was at the hospital on April 10, 2025 23:11 PDT.

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

Exit interview conducted, today's reports and appeal rights were reviewed and issued to Administrator Roberto Dela Vega.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/21/2025 05:30 PM - It Cannot Be Edited

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: REESEJOY CARE HOME
FACILITY NUMBER: 567609703

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2025
Section Cited
CCR
87705(b)(2)

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(2) For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through ...observation, to require awake night supervision. ...This requirement is not met as evidenced by:
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Administrator agrees to place awake staff during overnight shifts and will submit schedule to CCL by 4/22/25.
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Based on interviews, the licensee did not comply with the above section by not having awake staff to ensure R1 did not elope the facility after observing wandering and eloping behavior, & elopement resulted in injury which poses an immediate health and safety risk to resident 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.
Kasandra LopezTELEPHONE: (818) 596-4343
Esther CortezTELEPHONE: (747) 230-2225

DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2025

LIC809 (FAS) - (06/04)
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