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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 04/15/2025
Date Signed: 04/15/2025 10:42:34 AM

Document Has Been Signed on 04/15/2025 10:42 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WE R ONE FAMILY HOME, INC.FACILITY NUMBER:
197609727
ADMINISTRATOR/
DIRECTOR:		TYRONE QUALSFACILITY TYPE:
735
ADDRESS:723 E. OLDFIELD STTELEPHONE:
(562) 644-7260
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 2DATE:
04/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Doretha WilhiteTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On 04/15/25 Licensing Program Analysts (LPAs) Lorena Casillas and Evelin Rios conducted an unannounced Case Management visit to this facility. LPAs were granted access by staff and the reason for the visit was disclosed. LPA Casillas asked staff to call Administrator, Tyrone Quals and the Administrator stated that they would not be able to meet with LPA. Administrator assigned staff member Doretha Wilhite to sign the report.

On 03/18/25 LPA Casillas conducted an unannounced subsequent visit to deliver two (2) complaint reports. During the visit LPA inquired about clients in the home and was informed that Client #1 (C1) was no longer residing in the home. Upon hearing this LPA inquired to C1’s situation and LPA was advised by two (2) staff members that were present, that C1 was served with an eviction notice on 01/27/25 due to C1’s behavior towards staff and C1’s refusal to take medication. LPA asked for documentation and LPA was handed a copy of two (2) Special Incident Reports, however staff was not able to produce confirmation that reports were sent in to Community Care Licensing (CCL). LPA asked for a copy of the eviction notice but staff were not able to produce it. LPA then delivered the reports that the visit was intended for and left.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 04/15/2025
NARRATIVE
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On 4/15/25 LPA Casillas and LPA Rios spoke to Administrator over the phone where Administrator states that SIR’s were sent to CCL, however when LPA asked about eviction notice Administrator stated that C1 left on their own and that eviction was rescinded. LPA asked when eviction notice was given to C1 and Administrator stated that they did not recall. LPA asked if eviction notice was provided to C1 Administrator stated that they did not recall, then stated again that it was rescinded. LPAs then spoke to two (2) staff members that were present and Staff #1 (S1) stated that they provided C1 with an eviction notice on 01/27/25, provided by the facility. Staff #2 (S2) stated that they were made aware that C1 was “served” with an eviction notice but did not witness the eviction notice being “served” to C1. LPA Casillas explained to staff members that SIR’s were not received for 1/27/25 and 2/4/25, however SIR’s sent before and after those dates have been received without any issues. The two (2) SIRs handed to LPA Casillas on 03/18/25 state that an eviction notice was provided to C1. LPAs also explained to Administrator and staff that fax number listed on the two (2) SIR’s provided to LPA in person, have the wrong fax number on them. LPA Casillas explained that had SIR’s been received then a call would have ensued in order to get eviction notice, however since this was not the case this will result in citations, please see 809-D page. LPAs explained the importance of properly reporting incidents to CCL in a timely manner. LPAs also explained the importance of conducting a proper eviction notice, making sure that eviction notice is in compliance with Title 22 and providing said documents to CCL in a timely manner.

Citations issued. Appeals rights discussed and provided. Exit interview conducted. Copy of report given to designated staff.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2025 10:42 AM - It Cannot Be Edited


Created By: Lorena Casillas On 04/15/2025 at 10:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2025
Section Cited
CCR
80068.5(e)

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80068.5 Eviction Procedures (e) The licensee shall mail or fax to the Department a copy of the 30-day written notice in accordance with (a) above within five days of giving the notice to the client. This was not met as evidence by:
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Designated staff discussed and agreed to vendorized training on Eviction Notices and Procedures by POC due date for all staff. Proof will be emailed to LPA.
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Based on interviews, observations and record review Administrator failed to provide CCL with a copy of the eviction notice issued to C1. This poses a potential health and safety risk to clients in care.
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Type B
04/25/2025
Section Cited
CCR80061(b)(1)

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80061Reporting Requirements (b) Upon the occurrence… of any of the events specified in (1) below…a written report … shall be submitted to the licensing agency within seven days following the occurrence of such event. This was not met as evidence by:
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Designated staff discussed and agreed to vendorized training on reporting requirements for all staff by POC due date. Proof will be sent to LPA via email.
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Based on observations, interviews, and record reviews Administrator failed to report two (2) incidents on 1/27/25 and 2/4/25 within seven (7) days of occurrence. This poses a potential threat to the health and safety of clients 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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Lorena Casillas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2025


LIC809 (FAS) - (06/04)
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