197603946-1-26-2023-31-AS-RRAZ-CPC3TF-20230223173151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603946
Report Date: 01/26/2023
Date Signed: 01/26/2023 12:09:54 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2023 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230118101233

FACILITY NAME:	STRAWBERRY FIELDS		FACILITY NUMBER:	197603946
ADMINISTRATOR:	DAVID JAMES TAYLOR		FACILITY TYPE:	740
ADDRESS:	434 E LANCASTER BLVD		TELEPHONE:	(661) 206-7925
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 6	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Julissa Duvon Hall		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility kitchen is in disrepair.

INVESTIGATION FINDINGS:

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On 1/26/2023, Licensing Program Analyst (LPA) arrived at the facility to conduct an unannounced complaint inspection. Upon arrival, LPA was greeted by a staff member (S1) and allowed entrance to the facility. LPA and S1 notified the Administrator of the purpose of the visit, an entrance interview was conducted over the phone.

It was alleged that the facility kitchen is in disrepair.

The broken countertop was initially observed by a credible witness on 2/9/2021 and subsequently on 12/22/2022. During today’s visit, LPA conducted a tour and observed the kitchen countertop to have a crack where the ends meet and put together with a piece of duct tape. LPA spoke to one staff (S3) over the phone, and S3 stated the Licensee was working on fixing the countertop. Based on observation and interviews, the allegation mentioned above is Substantiated at this time. Deficiencies issued per CA Code of Regulations, Title 22. Report signed and delivered. Exit interview conducted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230118101233

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY FIELDS	FACILITY NUMBER: 197603946
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/02/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Licensee has agreed to fix the kitchen countertop crack. The Licensee will submit the invoice showcasing the order for the repair and submit photos to show that the countertop has been repaired.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on LPA observations and interviews, the facility did not ensure that the kitchen countertop was kept in good repair. Poses an potential health and safety or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

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