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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609727
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:35:21 PM

Substantiated


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
09/25/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240925143605
FACILITY NAME:WE R ONE FAMILY HOME, INC.FACILITY NUMBER:
197609727
ADMINISTRATOR:TYRONE QUALSFACILITY TYPE:
735
ADDRESS:723 E. OLDFIELD STTELEPHONE:
(562) 644-7260
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
09/30/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tyrone QualsTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not follow residents care plan.
Staff yelled at resident.
INVESTIGATION FINDINGS:
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On 09/30/2024 at 10:00 AM Licensing Program Analysts (LPAs), Lorena Casillas and Leslie Ngo-Castaneda conducted an unannounced complaint visit to investigate the above stated allegations. LPAs met with Back Up Administrator Jackie Page and explained the reason for the visit. Administrator Tyrone Quals arrived at 11:30am to the facility. North Los Angeles Regional Center (NLARC) staff was also present for the visit.

At 10:00 AM LPAs Casillas and Ngo-Castaneda conducted a physical plant tour with the Administrator. During the investigation, interviews and record reviews were conducted from 10:00 am to 12:00pm. LPA requested client roster, LIC 500, Bond and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including, but not limited to, client records, and any other information pertaining to client care. Three (3) clients out of four (4) were present during the visit. One (1) staff member was present when LPA’s arrived and one (1) staff arrived shortly after.
Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
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 4
Control Number 31-AS-20240925143605
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: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
VISIT DATE: 09/30/2024
NARRATIVE
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Allegation: Staff did not follow residents care plan.

It is alleged that staff did not follow residents care plan. Regarding this allegation it is reported that there was no staff available to follow Client #1 (C1’s) care plan of having two on one (2:1) staff twenty four hours (24hrs) a day seven (7) days a week. LPA interviewed Administrator who admitted that they have not hired enough staff yet to accommodate C1 and their care plan. LPA interviewed staff #1 (S1) and staff #2 (S2) who also confirmed that there is no additional staff to accommodate C1’s care plan. During the visit LPAs confirmed that C1 did not have 2:1 staff available to care for C1’s needs. During the investigation LPA Casillas reviewed C1’s care plan and confirmed that C1 in fact does need 2:1 staff 24/7 to care for C1’s needs. Therefore, based on interviews, observations and record reviews this allegation is deemed Substantiated.

Allegation: Staff yelled at resident.

It is alleged that staff yelled at client. Regarding this allegation it is reported that staff yelled at Client #1 (C1) during a behavioral episode. LPA interviewed Administrator and the allegation was denied stating that the staff that yelled at C1 was 360 Behavioral Health staff assigned to C1 as two on one (2:1) staff provided through a vendor via North Los Angeles Regional Center (NLARC) and not facility staff. Interviews with two (2) out of four (4) clients that were able to communicate with LPA confirmed that facility staff do yell at clients, it was also revealed that 360 staff does yell at C1 constantly without facility staff intervening. Therefore, based on observations and interviews this allegation is deemed Substantiated.

Citations issued. Please see LIC9099-D page. Exit interview conducted. Appeals rights discussed and provided. A copy of this report provided to Administrator.

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

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20240925143605
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: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2024
Section Cited
CCR
85078(a)(1)
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85078 Responsibility for Providing Care and Supervision(a) In addition to Section 80078, the following shall apply: (1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This was not met in evidence by:
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Licensee agreed to allow 360 behavioral health staff to assist C1 with additional staff to satisfy care plan. A log to reflect staff arriving and leaving will be emailed to LPA by POC due date. Following this Licensee will email said log to LPA on a weekly basis for the next 4 weeks.
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Based on interviews, record reviews and observations the Licensee did not ensure to provide qualified staff to follow C1’s care plan of having 2:1 staff 24/7 as written on the care plan. This poses an immediate health and safety risk to clients in care.
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Type A
10/01/2024
Section Cited
CCR
85065.5(a)(1)
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85065.5 Day Staff-Client Ratio (a)(1) Whenever a client... the following minimum staffing requirements shall be met: (1) For Regional Center... staffing shall be maintained...but no less than one direct care staff to three such clients. This was not met in evidence by:
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Licensee agrees to immediately provide the adequate number of staff to cover each shift as required. Licensee will provide an updated LIC500 to reflect days and hours of all staff by POC due date.
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Based on interviews, record reviews and observations the Licensee failed to maintain the staff ratio as specified by the regional center as clients were left without adequate supervision which poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20240925143605
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: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This was not met as evidence by:
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Licensee agrees to have all facility staff take vendorized training on Personal Rights and will submit proof of training and log with staff signatures to LPA by POC due date.
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Based on observations and interviews the Licensee failed to ensure that clients personal rights were protected in which staff yelled at clients in care. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4