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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607726
Report Date: 03/18/2022
Date Signed: 03/18/2022 01:46:53 PM


Document Has Been Signed on 03/18/2022 01:46 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:WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTERFACILITY NUMBER:
197607726
ADMINISTRATOR:ELVIE ANCHETAFACILITY TYPE:
740
ADDRESS:45221 30TH STREET WESTTELEPHONE:
(661) 974-7035
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: 47DATE:
03/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elvie Ancheta, Administator TIME COMPLETED:
02:15 PM
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At 10:30 a.m. Licensing Program Analysts Shira Stamps and Melissa Ruiz arrived at the facility to conduct a Case Management – other visit. LPAs were greeted by security staff and later met with the Administrator, Elvie Ancheta. An entrance interview was conducted, and LPAs explained the purpose of the visit.

The Woodland Hills Regional Office received information regarding an incident that may have occurred between a resident and the Administrator during the Allied Council Meeting on December 1, 2021. It was alleged that the Administrator yelled and treated a resident with disrespect. LPAs interviewed staff and residents from 10:40am-1:25pm. Based on interviews it was found that three (3) out of four (4) individuals interviewed stated the Administrator did not raise her voice at the resident, and that the resident was yelling at the Administrator.

Exit interview conducted and copy of report delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira StampsTELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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