425802105-8-19-2021-29-AS-KBUY-C7BQEW-20210929120700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802105
Report Date: 08/19/2021
Date Signed: 08/19/2021 06:34:55 PM

Unsubstantiated

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
07/28/2021 and conducted by Evaluator Toan Luong

COMPLAINT CONTROL NUMBER: 29-AS-20210728115134

FACILITY NAME:	PEOPLE'S CARE LAKE MARIE		FACILITY NUMBER:	425802105
ADMINISTRATOR:	CHARLOTTE ACOSTA HILL		FACILITY TYPE:	735
ADDRESS:	2186 LAKE MARIE DR		TELEPHONE:	(805) 314-2093
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	4	CENSUS: 4	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Lacey Hemeon, House Manager		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility administrator is not present at the facility an adequate number of hours

INVESTIGATION FINDINGS:

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On 8/19/21 at 1:30 PM, LPA Luong conducted an unannounced complaint visit to the facility to deliver final findings of the complaint allegations. LPA met with House Manager Lacey Hemeon and explained the purpose of the visit.
Allegation #2: Facility administrator is not present at the facility an adequate number of hours.
On 8/3/21, LPA conducted interviews with staff, clients, and administrator on-site at 9:47AM, 9:53 AM, 9:58 AM, 10:24 AM 10:37 AM, 10:45 AM, 11:18 AM, and 1:18 PM on-site. LPA conducted interviews with staff, clients, and administrator.
On 8/3/21, LPA reviewed documentation provided by facility’s IT department. Documentation tracks location of mobile device of administrator. Devices provided to administrator is managed through a Mobile Device Management software. Software pings the location of cellphone roughly every hour to track location of device. Cells in Excel documents are locked preventing edits to the document. Data shows location of device during each ping.
(Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Toan Luong
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210728115134

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: PEOPLE'S CARE LAKE MARIE	FACILITY NUMBER: 425802105
	VISIT DATE: 08/19/2021

NARRATIVE

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(Continued from 9099)
LPA reviewed spreadsheet and calculated the following:
Administrator was present at the facility 58 hours between 7/6/21 to 7/20/21 and 25 hours between 7/21/21 to 7/27/21. Spreadsheet does not capture exact data of when administrator arrives nor leaves facility. Based on interviews and document review, administrator was adequately present at the facility meeting TCRC requirement of 20 hours per week. This allegation is deemed to be unsubstantiated.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Toan Luong
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

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