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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:00:01 PM

Document Has Been Signed on 10/09/2024 04:00 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.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: 4DATE:
10/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Jaqueline PageTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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At 02:45 p.m. on 10/09/2024, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced case management visit. LPA met with the Back Up Administrator Jacqueline Page and disclosed the reason for the visit.

Today’s case management visit is to follow up on a series of unusual incidents previously reported on 10/03/24 to 10/05/24 by the facility in which Clients #1 (C1) is continuously attacking two on one (2:1) staff as well as facility staff. The purpose of the visit is to obtain additional information regarding these incidents.

LPA interviewed Back Up Administrator, staff #1 (S1) from 2:245 pm to 04:00 pm.

On 10/03/24 C1 had a behavior episode where C1 continuously physically attacked staff to the point that staff was not successful in redirecting C1, therefore staff called 911. The behavior from C1 has continued on a daily basis and redirection is not always successful. Staff has had the need to call 911 to get assistance with C1’s escalating behavior. Facility is working with behavioral staff, NLARC and 2:1 360 staff to try to manage C1’s behavior while a new facility is secured by NLARC for C1. Facility has sent appropriate special incident reports to Community Care Licensing, Adult Protective Services, and North Los Angeles Regional Center. Currently C1 is hospitalized and is not at the home.

Since the Back Up Administrator has taken the appropriate actions to ensure staff are appropriately caring for C1 and that protocols are being followed for C1’s behaviors, there are no deficiencies cited at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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