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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610084
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:23:53 PM

Document Has Been Signed on 08/28/2024 04:23 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EASTERSEALS SOUTHERN CALIFORNIA INCFACILITY NUMBER:
197610084
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, CYNTHIAFACILITY TYPE:
775
ADDRESS:44480 20TH STREET WTELEPHONE:
(818) 388-7428
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 100CENSUS: 51DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Carlos Guillen, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
04:37 PM
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At 1:00 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted unannounced case management visit to the facility. LPA met with the Program Director, Carlos Guillen and explained the purpose of this visit, LPA conducted a physical plant tour and requested documents.

On 08/22/2024, an incident was reported to the department stating that on 08/21/2024 Client #1 (C1) was inappropriately touched by Staff #1 (S1). Report states, On Wednesday August 21, 2024, client#1(C1) made a report to staff #2 (S2) stating they were inappropriately touched by staff #1 (S1). According to S2, when asked where they were touched C1 pointed at their pelvic area and when asked who touched them C1 pointed at S1. Staff and C1 reported the incident to the Program Director Carlos Guillen. Carlos asked Edward if the incident had taken place today, and C1 repeated the word today.

On 08/28/24, from approximately 1:20 p.m. to 3:00 PM. LPA interviewed three (3) staff, five (5) clients and contacted the Sheriff's department. During interviews, Staff #2 (S2) stated that on 08/21/2024 they had a visual on C1, who was walking "laps" around the facility during the time the alleged incident occurred. S1 states they did not observe C1 have interactions with S1 prior to C1 pointing S1 out. In LPA's interview with S1, S1 denied the allegation and sates they have not had interactions with C1 prior to this incident. According to Staff #3 (S3) they witnessed C1 enter a bathroom located in view of their office and states they did not witness anyone else entering behind C1. S3 also stated C1 and S1 who was already walking around the facility with another client were walking towards each other. S3 states there was a verbal exchange between C1 and S1 that C1 appeared to have initiated then S3 states C1 walked away with S2. S3 states they had not witness an interaction between C1 and S1 before. LPA's interview with C1, C1 stated "yes" when asked if someone had inappropriately touched them, but did not provide further information regarding the incident in question. LPA's Interview with four (4) clients did not reveal any corroborating evidence to the allegation.

(CONT. on LIC 809-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: EASTERSEALS SOUTHERN CALIFORNIA INC
FACILITY NUMBER: 197610084
VISIT DATE: 08/28/2024
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 LPA's interview with the Program Director revealed once the report was made to them by C1 with S2 present they followed all mandated reporting protocols contacting the Lancaster Sheriff Department, Adult Protective Service, Community Care Licensing, North Los Angeles County Regional Center and C1s responsible party. According to the Program Director there was a previous allegation made by C1 about S1 and when the Program Director spoke to C1's responsible party, they stated C1 has continued to repeat the same information possibly indicating C1 is repeating the allegation from back then. According to the program director the previous allegation was unsubstantiated on 2022.

S1 is currently on administrative leave but may return to work after North Los Angeles County Regional Center concludes their investigation. Based on the current information reviewed by LPA no further action will be taken. LPA did not find any witnesses to the allegation and the interviews conducted did not reveal any corroborating statements. Program Director was advised if additional information becomes available further investigation may be required.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of report was issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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