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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801748
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:02:20 PM


Document Has Been Signed on 06/14/2023 02:02 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:SAILS LA LOMAFACILITY NUMBER:
565801748
ADMINISTRATOR:CRISTINA MARCIAFACILITY TYPE:
735
ADDRESS:2065 ERBES RDTELEPHONE:
(818) 676-9831
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:4CENSUS: 4DATE:
06/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Joanna IniguezTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced case management visit and met with the District Manager (DM), Joanna Iniguez. 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 (CCL) office, regarding R1 #1 (R1's) Violation of Personal Rights. During today’s visit, interview was conducted with the DM and staff present at the facility, S1 was unavailable for an interview. R1 was unavailable for interview. Resident’s records were reviewed. Record review for case notes for R1 dated from 03/31/2023 to 06/12/2023, indicate that R1 is independently getting up at night. Based on the review of record and interviews conducted, it appears that R1 is free to get up, and move about the facility as needed for personal.
Further investigation is needed at this time.

Exit interview conducted with District Manager Joanna Iniguez. Copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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