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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802105
Report Date: 06/06/2022
Date Signed: 06/06/2022 03:17:15 PM

Document Has Been Signed on 06/06/2022 03:17 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PEOPLE'S CARE LAKE MARIEFACILITY NUMBER:
425802105
ADMINISTRATOR:MARIA DRUMMONDFACILITY TYPE:
735
ADDRESS:2186 LAKE MARIE DRTELEPHONE:
(805) 314-2093
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 4CENSUS: 4DATE:
06/06/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:M. Drummond, and Managment Peoples Care et al. TIME COMPLETED:
02:00 PM
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 At 1:00pm on 06/06/2022 An announced virtual Office Meeting was conducted to discuss concerns regarding recent complaints and citations at this facility, and concerns called in to Community Care Licensing (CCL) from members of the community.

Present at today’s meeting were: Licensing Program Analyst (LPA) Mark Jeffries, Licensing Program Manager (LPM) Kelly Burley, Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Vincent Figueroa , TCRC Quality Assurance Manager Freddie Garcia, and Licensee Representatives Abe Avila, Richard Rubio, Christopher Trevilla, Joanna Iniguez, Maria Drummond, Michelle Mainez.
· LPM discussed an incident where a lack of staff supervision led to a client leaving the facility without staff’s awareness. The client walked into a neighbor’s home at night, and the neighbor alerted the facility about the client’s whereabouts.

o Licensee Representatives stated they were retraining all staff on various topics including AWOL/elopement procedures and preventing and managing elopements, personal rights, line of sight, and missing person protocols for each client.

o LPM also suggested to check that door alarms placed on egress doors are functional. TCRC QAS recommended checking fence alarms as well.

· LPM discussed a recent incident where a staff improperly restrained a client, and the restraint was not reported to CCL. Additionally, when interviewed, the staff denied having CPI training even though a training certificate indicates the staff had the training about two months prior to the incident.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2022
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PEOPLE'S CARE LAKE MARIE
FACILITY NUMBER: 425802105
VISIT DATE: 06/06/2022
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o LPM suggested retraining all staff on personal rights, which the Licensee Representatives stated they are already working on.

o LPM suggested retraining all staff on the facility’s Emergency Intervention Plan regarding restraints, and review CCR sections 85102, 85122, 85161, 85165, 85168, 85168.2, 85168.3, 85169.

o Licensee representatives stated they will be retraining staff in CPI that includes an online portion, hands on training, and hip to hip training.

· LPM discussed the importance of promptly providing paperwork requested by CCL as well as TCRC.

o Licensee Representatives agreed and are also working to ensure a smooth transition between outgoing and incoming employees in regards to communication and access.

· LPM discussed concerns CCL has received from community members regarding the facility. LPM reminded Licensee Representatives of the Neighborhood Complaint Policy the Licensee submitted on 8/16/2016 as part of the facility’s plan of operation.

o LPM requested that the Licensee Representatives ensure they comply with their Neighborhood Complaint Policy, or make any necessary updates and resubmit an updated Policy to CCL.

o Licensee Representatives agreed to submit an updated policy that provided more specifics and aligned with their updated company structure.

Licensee Representatives stated they have created new layers of oversight to allow for more monitoring, are retraining staff in the home on various topics, have quality assurance continually assessing the staff for additional training, and welcome collaboration between CCL and TCRC.



Report emailed to the Licensee Representatives for signature.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
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