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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610332
Report Date: 06/03/2025
Date Signed: 06/03/2025 05:35:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250212084901
FACILITY NAME:PEOPLE'S CARE LANCASTER C12FACILITY NUMBER:
197610332
ADMINISTRATOR:CORTES, CRYSTALFACILITY TYPE:
738
ADDRESS:8543 W AVENUE C12TELEPHONE:
(909) 287-3557
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 2DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Yolanda Pickens - AdministratorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Insufficient supervision resulted in injury to a client.
INVESTIGATION FINDINGS:
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On 06/03/2025, Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct an unannounced subsequent complaint visit to deliver findings on the above allegation. LPA met with Yolanda Pickens the administrator and explained the reason for this visit.

Allegation: Insufficient supervision resulted in injury to a client. It was alleged that care and supervision is not being implemented according to the client#1's (C1's) care plan which resulted in C1 sustaining an injury. To investigate the allegation, LPA Rios conducted an initial unannounced complaint visit on 02/19/2025. During that visit from 12:21 p.m. to 1:50 p.m., LPA conducted interviews with two (2) out of (2) clients, and five (5) staff members present. LPA reviewed and obtained copies of C1’s record which included but is not limited to current Individual Program Plan (IPP), Behavior Frequency Chart, Body check conducted on 09/05/2024 and updated December 2024 Behavior Intervention Plan Snapshot, and Functional Behavior Assessment. LPA also reviewed and obtained copies of the facility’s LIC500 and 24-Hour Staff Schedule.
(Continue to LIC9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 2
Control Number 31-AS-20250212084901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PEOPLE'S CARE LANCASTER C12
FACILITY NUMBER: 197610332
VISIT DATE: 06/03/2025
NARRATIVE
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(Continued from LIC9099) Review of C1's IPP revealed C1 has a history of aggression and disruptive behavior. Most recent Behavior Intervention Plan Snapshot and Functional Behavior Assessment revealed C1 engages in self-injuries behavior such as biting. Interviews with two (2) staff, the administrator and the assistant administrator that worked in the facility when C1 was initially admitted corroborate C1 had injuries to hands when C1 was admitted to the facility. Interview with five (5) staff corroborate witnessing C1 biting their hand and/or picking at scabs and threatening to bite themselves. Review of C1’s records revealed C1 is supervised by (02) staff. Interview with five (05) staff deny C1 has been left unsupervised. According to C1’s Behavior Support Plan, not verbatim, staff should block C1’s ability to exhibit aggression by first using verbal de-escalation, blocking strategies and last, CPI when needed. LPA’s interview with C1 denied being left unsupervised and showed LPA makings on their arm and stated they had done it to themselves. LPA observed healed circular shaped wounds on top of C1’s left and right hand and scratches on the top of C1’s left hand. Interview with client #2 (C2) denied witnessing C1 left unsupervised. LPA was unable to find corroborating evidence that care and supervision is not being implemented according to the client#1 (C1's) care plan which resulted in C1's sustaining an injury. Based on record review and interviews there is not enough sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

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

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

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2