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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800551
Report Date: 10/09/2023
Date Signed: 10/09/2023 04:27:35 PM

Document Has Been Signed on 10/09/2023 04:27 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:GABLES OF OJAI, THEFACILITY NUMBER:
565800551
ADMINISTRATOR:MATTEO DIGRIGOLIFACILITY TYPE:
740
ADDRESS:701 N. MONTGOMERY ST.TELEPHONE:
(805) 646-1446
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY: 118CENSUS: 79DATE:
10/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Matteo DigrigoliTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced Case Management -Deficiencies visit in conjunction with an initial complaint visit (Complaint Control#29-AS-20231002090407). The purpose of the visit is to issue citations for deficiency observed during the complaint investigation which is not related to the complaint. The LPA arrived at the facility at 09:20AM and was greeted by Marketing Director Christine Fenn and discussed the reason for the visit. Administrator Matteo Digrigoli arrived later during the visit.

At 9:40 a.m. during today's visit the LPA toured the facility with Marketing Director Christine. At 10:58 a.m the LPA observed one (1) full bottle of Dona Sol Merlot, and one (1) full bottle of Barefoot Merlot in an unlocked cabinet inside the dining room of the memory care unit accessible to the residents in care. At 11:01 a.m. the LPA observed a tool box with the following variety of tools: hammer, pliers, screw drivers and other tools inside an unlocked cabinet in the dining room of the memory care unit. At 11:58 a.m. the LPA observed a Clorox spray bottle, a pet stain and odor eliminator spray and disinfectant wipes in the living kitchenette area of room #34 accessible to residents in care.


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

Exit interview conducted, today's reports and appeal rights were provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
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 10/09/2023 04:27 PM - It Cannot Be Edited


Created By: Esther Cortez On 10/09/2023 at 03:47 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: GABLES OF OJAI, THE
FACILITY NUMBER: 565800551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2023
Section Cited
CCR
87705(f)(1)

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87705 Care of Persons with Dementia(f)(1) The following shall be stored inaccessible to residents with dementia: Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).

This requirement is not met as evidenced by
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Staff locked all items during todays visit Administrator stated that they will provide documentation staff training regarding regulation 87705(f)(1) to CCL by 1/6/22.
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Based on LPA's observations, the licensee did not comply with the section cited above as cleaning supplies, bottles of merlot,hammer and other tools were observed accessible to residents which posed an immediate safety 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:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2023


LIC809 (FAS) - (06/04)
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