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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700073
Report Date: 02/07/2023
Date Signed: 02/07/2023 06:13:50 PM

Document Has Been Signed on 02/07/2023 06:13 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PEOPLE'S CARE WINFINFACILITY NUMBER:
342700073
ADMINISTRATOR:EKUNDARE, ADEBIMPEFACILITY TYPE:
735
ADDRESS:3418 WINFIN WAYTELEPHONE:
(916) 480-9660
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 3DATE:
02/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:CaregiversTIME COMPLETED:
01:45 PM
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On 2/7/23,Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced to conduct a case management visit. LPA met with caregivers and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed the department's required COVID-19 protocols. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility. Administrator was called and arrived to assist.

The department received SOC 341s for incidents on 1/27/23 involving S1 and R2 and R1 respectively.
LPA conducted interviews of Administrator, S2 and S3. S1 is not present at the facility. LPA requested documentation of S1's employment, training and supervisory actions.

S1 was reported to loudly swear an exclamation when she found that R2 had had a incontinence of bowel accident upon waking from a nap. S1 was given a break and instruction. A short time later, S1 was report to have, on 1/27/23, pushed R1, resulting in R1 falling with no injuries when S1 grew impatient regarding R1 not returning to the house for shoes as requested.

S1 was retrained on personal rights of residents following the incidents. On 1/27/23 S1 was put on administrative leave and has not returned to work at this home.

It is found that S1 violated the personal rights of residents in both the 1/27/23 incidents. Further action by the department will be considered. As a result of this visit, no citation is issued at this time. Report reviewed with Kourtney Hamilton . Copy of this report and appeal rights provided.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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