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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604300
Report Date: 12/11/2023
Date Signed: 12/11/2023 02:07:32 PM

Document Has Been Signed on 12/11/2023 02:07 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PALM VALLEY GROUP HOMES, INC.FACILITY NUMBER:
197604300
ADMINISTRATOR:EILEEN VASQUEZFACILITY TYPE:
735
ADDRESS:43944 DELGADO CT.TELEPHONE:
(661) 946-3435
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
12/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Eileen VasquezTIME COMPLETED:
02:25 PM
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Licensing Program Analysts (LPAs) Lorena Casillas and Evelin Rios conducted a Case Management - Incident visit. LPAs met with Administrator Eileen Vasquez. LPAs explained the reason for the visit.

On 12/05/23, the department received a self reported incident stating that Right Choice Staff #3 (S3) was told by Right Choice weekend Staff #2 (S2) that Facility Staff #1 (S1) was observed hitting Resident #1 (R1).
Right Choice is a vendorized agency by North Los Angeles County Regional Center (NLACRC) hired by this facility to provide one on one care to residents.

LPA Rios along with S4 conducted a physical plant inspection of the facility to assure the health and safety of the residents in care. LPA did not observe any health and safety issues or concerns on today's visit.

During today’s visit Administrator was interviewed by LPA’s. In interviewing Administrator, it was stated that Staff #3 (S3) was told by Staff #2 (S2) that R1 was hit with an open palm by S1. There was no time or place indicated, all information that was attained was that it happened during the weekend. Based on interviews, R1's family and NLACRC were informed of the incident. S3 reported the incident to Administrator. S1 was removed from duty. S2 denies reporting incident to S3 and denies witnessing the incident. LPAs conducted interviews with S4 and S5, and both staff members denied that they have witnessed S1 slap R1. During today's visit, LPAs reviewed facility records, interviewed staff, and attempted to interview clients.

Due to no corroborating witness, no visible injuries, and no history of similar allegations against staff in question there was not enough evidence to prove the incident reported to Community Care Licensing did or did not occur.

No deficiencies issued at this time. Exit interview conducted and a copy of the report provided to Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2023
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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