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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850047
Report Date: 07/30/2024
Date Signed: 07/30/2024 11:23:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240729095432
FACILITY NAME:VALLEY VISTA RESIDENTIAL CARE IIIFACILITY NUMBER:
405850047
ADMINISTRATOR:CORRALES, NELLIE SFACILITY TYPE:
740
ADDRESS:1557 GALLEON WAYTELEPHONE:
(805) 439-4120
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:6CENSUS: 4DATE:
07/30/2024
UNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Licensee Evelyn StrampeTIME COMPLETED:
12:17 PM
ALLEGATION(S):
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Uncleared individuals are present with the residents.
INVESTIGATION FINDINGS:
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 At 10:10am on 07/30/2024, Licensing Program Analyst (LPA) LPA Jeffries arrived unannounced to the facility. LPA met with Licensee Eveyln Strampe announced who he is and the reason for the visit.

At 11:00am on 07/30/2024, LPA referred to Guardian Register a list of cleared staff for the facility and noted that the staff working during visit was identified as Staff 1 (S1) and was cleared as evidence of Guardian Roster searched on 07/30/2024. LPA interviewed Licensee Evelyn Strampe who admitted that Son (F1) has been visiting the past week from Canada who is not cleared and has been residing in empty bedroom, who has no fingerprinting and no background clearance. LPA noted that the facility will be assessed a citation for the past 5 days for having Non cleared individual residing in the facility. LPA informed Licensee that F1 will no longer be able to reside in the facility while residents are present. This admission resulted in a violation and civil penalty.

Exit interview, report read, appeal rights, and report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
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 29-AS-20240729095432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA RESIDENTIAL CARE III
FACILITY NUMBER: 405850047
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2024
Section Cited
CCR
87355(a)
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87355 Criminal Record Clearance
(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or
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Licensee agrees to help proved accommodations that are not in licensed facilities for family members or individuals visiting from out of town.
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 presence in the facility, based upon the results of such review. This requirement was not met by admission of Licensee, as to F1 residing in the facility for the past 5 days. Which poses a risk to residents 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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2