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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 03/18/2025
Date Signed: 03/18/2025 10:31:50 AM

Document Has Been Signed on 03/18/2025 10:31 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:
03/18/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Doretha WilhiteTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
NARRATIVE
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Licensing Program Analyst (LPA) Lorena Casillas met with Doretha Wilhite for a case management visit. The purpose of the case management visit is to address deficiencies observed during the course of investigation for complaint # 31-AS-20240523125725. The deficiencies were not alleged but related to the complaint. Administrator was not able to meet with LPA and assigned House Manager (HM) Doretha Wilhite to sign the report. Entrance interview conducted.

On 05/28/24 LPA Casillas was made aware that on 05/15/24 Client #1 (C1) did not have proper care and supervision causing C1 to end up wandering alone on the 14 freeway and subsequently on a psychiatric hold. During the investigation it was revealed that 2:1 vendor Brea 360 did not have sufficient staff to provide C1’s 2:1 coverage, only providing 1:1 staff. It was also discovered via an email provided to LPA by House Manager (HM) Vashan Bobney that it was relayed by HM to Brea 360 that the facility would not be able to provide additional staff due to not being paid for additional 2:1 coverage for C1. LPA explained to current HM that when there is not enough staff provided by a vendor, it is the facilities responsibility to provide additional staff to cover client needs as described on needs and services plan. Based on the information provided a deficiency and civil penalty will be issued for a repeat violation.

Exit interview conducted. Appeal Rights discussed and issued. Copy of report given to HM.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/18/2025 10:31 AM - It Cannot Be Edited


Created By: Lorena Casillas On 03/18/2025 at 10:15 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: 03/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2025
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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House Manager agrees to have sufficient staff to meet client needs. HM will continue to submit LIC500 to reflect coverage to LPA via email. POC was cleared during LPA visit as there is sufficient staff and LIC 500 has been submitted on a weekly basis.
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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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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Lorena Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
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