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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609334
Report Date: 04/27/2023
Date Signed: 04/27/2023 12:57:05 PM

Document Has Been Signed on 04/27/2023 12:57 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: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:
04/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Amparo Murvin, AdministratorTIME COMPLETED:
01:30 PM
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On 4/27/23 at 12:30pm, Licensing Program Analyst (LPA) Shira Stamps conducted a case management visit in conjunction with complaint visit 31-AS-20230424111908. The purpose of this case management visit is to address the incident report that occurred on 4/9/23. The facility reported to the Licensing Department that on 4/9/23, staff member one (S1) drove three (3) clients to church services without a license. Based on interviews it was found that once the Administrator was informed of the incident it was reported to the appropriate parties. Currently HR is determining if S1 will be terminated. The Administrator stated all staff are currently taking service training regarding safe driving. LPA reviewed training documents, and earlier in April of 2023 all staff, including S1, received training on driving safely before the incident occurred. LPA requested documents of which staff members completed today’s service training.

Exit interview conducted. Copy of report delivered to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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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