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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609294
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:22:49 AM

Document Has Been Signed on 08/07/2024 11:22 AM - 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:DIVINE FUTURES IIFACILITY NUMBER:
197609294
ADMINISTRATOR/
DIRECTOR:		PRISCILLA ISORDIAFACILITY TYPE:
735
ADDRESS:3631 E AVENUE H-10TELEPHONE:
(818) 270-6434
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
08/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Priscilla IsordiaTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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At 09:45 a.m. on 08/07/2024, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced case management visit to this facility. LPA met with the Administrator Priscilla Isordia and disclosed the reason for the visit.

LPA was greeted by staff member and was granted access. Staff member then proceeded to call Administrator who arrived shortly after.

Today’s case management visit is to follow up on an incident previously reported on 08/01/24 by the facility in which one on one (1:1) staff allegedly slapped Client #1 (C1) causing C1 distress. The purpose of the visit is to obtain additional information regarding this incident.

LPA interviewed Administrator, Staff #1 (S1) via telephone, Staff #2 (S2) and Client #1 (C1) from 10:00 am to 11:15 am.

Continued on 809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DIVINE FUTURES II
FACILITY NUMBER: 197609294
VISIT DATE: 08/07/2024
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On 8/01/24 at approximately 5:45 am C1 needed help getting cleaned after soiling themselves. While facility staff was cleaning the mop used to clean C1’s room in the restroom, a commotion was heard in C1’s room. S1 states that they heard what sounded like a slap and then C1 was crying, S1 immediately returned to C1’s room and noticed C1 visibly distressed. When S1 questioned the 1:1 staff member about what had just occurred S1 was told by 1:1 that nothing happened. S1 stated that 1:1 staff seemed upset and did not want to answer questions. S2 was entering the facility as they were scheduled to start work at 6:00am and S1 let S2 know what was going on. S2 immediately contacted Administrator who then shortly arrived at the facility. S2 noticed a clear slap mark with finger indentations on C1’s right cheek and proceeded to take a picture. Per Administrator 1:1 had already left the facility therefore Administrator proceeded to call 1:1 and ask for an explanation. According to Administrator 1:1 simply stated that nothing had happened, when Administrator asked regarding marks on C1’s cheek the 1:1 staff member stated that they did not touch C1 and no further information was shared. Prior to Administrators’ arrival, Administrator had already contacted Right Choice Supervisor to appraise them of the situation and demand that 1:1 be removed from services immediately. 1:1 staff are not direct facility staff, they are contracted through Right Choice In-Home Care, a vendor though North Los Angeles Regional Center (NLARC). Per Administrator the 1:1 staff was removed from the facility immediately and a new 1:1 staff member was requested and provided for C1. The previous 1:1 is not allowed in the facility at all. The Administrator will hold a training course with all staff to go over client rights. The Administrator reported the incident appropriately to Community Care Licensing (CCL), NLARC, Adult Protective Services (APS), Long Term Care Ombudsman (LTCO) and removed 1:1 staff permanently.

Since the Administrator has taken the appropriate actions to ensure staff understand client rights, there are no deficiencies cited at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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