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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605589
Report Date: 11/02/2023
Date Signed: 11/02/2023 02:11:44 PM

Document Has Been Signed on 11/02/2023 02:11 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RAWATES INC.FACILITY NUMBER:
197605589
ADMINISTRATOR:SUJATA RAWATEFACILITY TYPE:
735
ADDRESS:20131 LABRADOR STREETTELEPHONE:
(818) 718-7806
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 5CENSUS: 5DATE:
11/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sujata Rawate, Administrator TIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Angela Panushkina conducted a Case Management (CM) visit to the facility to follow up on an Incident Report (IR), that was received on 10/24/23 from a Day Program. It was reported that on or around 12:10PM, Staff noticed 2 small bruises on C1's right forearm above the wrist. When staff asked C1 about the bruises, C1 was unclear and mentioned that it happened at home/facility (Rawates Inc.) (C1) was handled inappropriately by Staff 1 (S1). Internal investigations was made by facility Administrator, Sujata Rawate, and based on the information the Administrator has obtained, there wasn't enough information to corroborate S1 handling C1 inappropriately. LPA was informed that C1 has behavior episodes and can self harm. Today's investigation consisted of interviews with two (2) staff, and back up Administrator. Interviews were also made with two (2) out of five (5) clients, who were able to communicate. Based on interviews obtained, there was insufficient evidence to corroborate that S1 handled C1 inappropriately. Therefore, no citations issued will be issued at this time.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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