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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609334
Report Date: 07/15/2024
Date Signed: 07/15/2024 12:28:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
07/10/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240710123956
FACILITY NAME:PEOPLE'S CARE GILLESPIEFACILITY NUMBER:
197609334
ADMINISTRATOR:LAKESHA BUCHANANFACILITY TYPE:
735
ADDRESS:4021 GILLESPIE RDTELEPHONE:
(661) 269-2676
CITY:ACTONSTATE: CAZIP CODE:
93510
CAPACITY:4CENSUS: 4DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Daniel MoralesTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff spoke to resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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On 07/15/2024 at 09:50 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Daniel Morales and explained the reason for the visit.

At 11:20 AM LPA Casillas conducted a physical plant tour with the Administrator. During the investigation, interviews and record reviews were conducted. LPA requested client roster, LIC 500, and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including, but not limited to, client records, staff records and any other information pertaining to client care. There were two (2) clients present at the facility, one (1) was out in the community and one (1) is currently hospitalized.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20240710123956
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PEOPLE'S CARE GILLESPIE
FACILITY NUMBER: 197609334
VISIT DATE: 07/15/2024
NARRATIVE
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Allegation #1: Staff spoke to resident in an inappropriate manner.

It was alleged that staff spoke to residents in an inappropriate manner. Regarding this allegation it was reported that Staff #1 (S1) spoke to Client #1 (C1) in an inappropriate manner by stating “I am not afraid of you guys”, causing C1 to be intimidated and feel unsafe. Interviews with four (4) staff that were present during this investigation, including the administrator, denied the allegation. LPA was able to call and interview S1 who also denied the allegation. LPA interviewed Client #2 (C2) and Client #3 (C3) who also denied the allegation. Based on interviews, there is no sufficient information to verify the allegation. Therefore, the allegation is deemed Unsubstantiated.

Exit interview conducted. Copy of report provided to Administrator.

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

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2