<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801424
Report Date: 12/19/2023
Date Signed: 12/19/2023 03:35:21 PM

Document Has Been Signed on 12/19/2023 03:35 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:ARC VC-COCHRANFACILITY NUMBER:
565801424
ADMINISTRATOR:KARIE RAGANFACILITY TYPE:
775
ADDRESS:5143 COCHRAN STREETTELEPHONE:
(805) 520-0399
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 90CENSUS: 51DATE:
12/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Joseph LaporteTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management – Incident visit at 1:45 p.m. for the purpose of investigating a self-reported incident report and SOC 341. Upon arrival, LPA met with Program Director, Joseph Laporte and Case Manager, Brianne Esseff, at this time the reason for the visit was explained. Entrance interview.

On 12/11/2023, the Department received an incident report stating on the afternoon of 12/11/2023, Staff #1 (S1) reported that Staff #2 (S2) had pushed and slapped Client #1 (C1) after C1 had lightly touched S2 on their side. S1 stated that C1 had lightly touched S2 to get their attention, S2 pushed C1 away and backed up before slapping C1 on their hand and yelling at C1 to not touch them. S1 immediately told S2 that they could not to that and S2 was seen storming out of the room upset.

During today’s visit, LPA conducted interviews with five staff and one client between 1:50 p.m. and 3:27 p.m., conducted a resident file review at 2:40 p.m., and obtained copies of pertinent documents relevant to the investigation. LPA has determined further investigation is needed and will return at a later date to continue.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1