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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801424
Report Date: 10/27/2023
Date Signed: 10/27/2023 01:47:45 PM

Document Has Been Signed on 10/27/2023 01:47 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: 66DATE:
10/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Joseph LaporteTIME COMPLETED:
02:00 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 today due to an incident report that was received by the Department on 09/22/2023. Upon arrival, LPA met with the Program Director Joe Laporte and explained the reason for the visit. Entrance interview.

An incident report (LIC 624) was reported by the facility regarding an incident that took place on 09/21/2023 where Participant #1 (P1) communicated to staff that another staff had punched them. P1 stated a staff member had punched and bit them on their left forearm.

During today’s visit, LPA conducted interviews with the program director, two (2) staff and one (1) participant between 10:00 a.m. and 10:30 a.m. and obtained copies of pertinent documents. Interviews conducted with staff revealed staff member and P1 were not observed alone at any time. At the time of the alleged incident, P1 and S1 were sitting on separate tables with two (2) other staff members present. A staff member asked P1 about a small bruise on their arm to which P1 stated a staff had just punched them causing the bruise on their arm. While interviewing P1, P1 did not report being touched inappropriately by any staff at any time during the day program. Additionally, P1 stated they enjoyed being part of the day program and being able to socialize with other participants. Furthermore, P1 denied being physically abused or observing other participants being abused by any staff member. At this time, there is no further follow-up action necessary on incident submitted by the day program.



(Report Continued on LIC 809C...)
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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 3
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: ARC VC-COCHRAN
FACILITY NUMBER: 565801424
VISIT DATE: 10/27/2023
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
26
27
28
29
30
31
32
(Report Continued from LIC 809C...)

Also, while conducting today’s visit, LPA observed a facility staff, Staff #1 (S1) who was not listed on the facility personnel report summary (LIS 536). Interviews conducted revealed S1 has been working at the day program for at least two (2) months every day, Monday through Friday. The LPA also reviewed the facility’s Guardian roster and discovered that S1 does have fingerprint clearance but is not associated to this facility.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty issued in the amount of $500. Failure to correct the deficiency may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/27/2023 01:47 PM - It Cannot Be Edited


Created By: Martha Arroyo On 10/27/2023 at 12:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ARC VC-COCHRAN
FACILITY NUMBER: 565801424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/27/2023
Section Cited
CCR
82019(e)(2)

1
2
3
4
5
6
7
Prior to working in a licensed day program, all individuals subject to a criminal record shall do the following: (2) Request the licensee or applicant for a license to request a transfer of a criminal record clearance. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility had S1 associated to the facility duirng the visit.

POC has been met.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above as S1 has fingerprint clearance, but is not associated to this facility, which poses an immediate safety risk to residents in care.
8
9
10
11
12
13
14
Civil Penalty issued today in the amount of $500.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Desaree Perera
LICENSING EVALUATOR NAME:Martha Arroyo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3