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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609334
Report Date: 03/11/2025
Date Signed: 03/11/2025 11:46:57 AM

Document Has Been Signed on 03/11/2025 11:46 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
N LA & CEN COA AC/SC, 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:
03/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Nadine Wills- Staff TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an unannounced Case Management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from the Facility for Staff #1 (S1)

On today's visit LPAs met with staff, Nadine Wills and explained the reason for the visit. LPAs also spoke with the administrator, Daniel Morales over the telephone as he was unavailable during the visit. Administrator instructed Staff, Nadine Wills to receive and sign report on his behalf. Nadine was served an Immediate Exclusion Order for Staff #1(S1). No immediate Health and Safety Hazard was noted during this visit.

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

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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