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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609334
Report Date: 04/10/2024
Date Signed: 04/10/2024 01:53:07 PM

Document Has Been Signed on 04/10/2024 01:53 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PEOPLE'S CARE GILLESPIEFACILITY NUMBER:
197609334
ADMINISTRATOR/
DIRECTOR:		LAKESHA BUCHANANFACILITY TYPE:
735
ADDRESS:4021 GILLESPIE RDTELEPHONE:
(661) 269-2676
CITY:ACTONSTATE: CAZIP CODE:
93510
CAPACITY: 4CENSUS: 4DATE:
04/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Daniel Morales CisnerosTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced case management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from Facility for Staff #1 (S1)

On today's visit LPA met with the Administrator, Daniel Cisneros and explained the reason for the visit. The Administrator was served an Immediate Exclusion Order for Staff #1 (S1). The administrator received permission for all immediate exclusion letters for all facilities that S1 was working at to be given to them as well at the People's Care McEnnery Canyon, #197609335.

No immediate Health and Safety Hazard was noted during this visit.


Exit interview held. A copy of the report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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