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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609954
Report Date: 11/20/2023
Date Signed: 11/20/2023 03:14:17 PM


Document Has Been Signed on 11/20/2023 03:14 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ARTESIAN OF OJAI, THEFACILITY NUMBER:
567609954
ADMINISTRATOR:AMBER L WINTERSTEINFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 38DATE:
11/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Amber Winterstein-AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Elsie Campos and Emily Peraldi conducted an unannounced Case Management - Incident inspection. At 1:55 p.m., the LPAs met with Administrator, Amber Winterstein and explained the reason for the visit.

The reason for today's inspection is to follow up on a self-reported incident report received on 11/20/2023. The report pertains to a personal rights violation of Resident #1 (R1). At 1:58 p.m., the LPAs conducted an interview with the Administrator. At 2:06 p.m., the LPAs obtained copies of pertinent documents. At 2:55 p.m., the LPA's along with the Administrator conducted a physical plant tour.

No immediate health and safety concerns were observed during today's inspection.

Further investigation is required at this time. A referral was made to Community Care Licensing Division's (CCLD) Investigation Branch (IB). Additional report may follow if warranted.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023
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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