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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801456
Report Date: 06/13/2024
Date Signed: 08/29/2024 03:34:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/04/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20240604141623
FACILITY NAME:CEDAR HOUSEFACILITY NUMBER:
565801456
ADMINISTRATOR:LOUISA MAE ESPENAFACILITY TYPE:
735
ADDRESS:161 MARKER AVENUETELEPHONE:
(805) 484-0271
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 6DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Louisa Mae EspenaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Client left without supervision in a car
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett. LPA and QAS met with the administrator Louisa Mae Espena and explained the reason for the visit.

LPA and QAS conducted interviews with client 1 (C1) at 3:05 p.m. and the administrator at 3:32 p.m.

The admininstrator stated she and C1 went to Costco in Oxnard together to assist one of the licensee's other facilities with locating a missing client. They arrived at Costco at 4:10 p.m. and entered the store. They walked at a fast pace through the store and down the aisles twice but did not locate the other client.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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-20240604141623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDAR HOUSE
FACILITY NUMBER: 565801456
VISIT DATE: 06/13/2024
NARRATIVE
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(continued from LIC9099)

They exited the store, got into the car and drove around the parking lot, then over to the parking lot across the street. They returned in the car and parked in front of the Costco Tire Center. At that point, C1 stated they were cold and wanted to sit in the car while the administrator went inside the Tire Center. C1 demonstrated they could open the car door if they needed more air and it was a cool, cloudy day. C1 was comfortable staying in the car waiting for the administrator. The administrator stated they were able to see C1 from the Tire Center. The administrator briefly gave contact information to Costco management in case they spotted the missing client from the other facility.

The administrator showed call history of her call at 4:28 p.m. to the other facility letting them know she was leaving to take C1 to an appointment. The entire search took a total of 18 minutes. In addition, C1 stated they were ok staying alone in the car. C1 stated they were hot to a citizen who stopped to check on them. However, when the administrator got into the car to leave, C1 requested the heater be turned on as they were cold.

Documentation was reviewed at 4:00 p.m. C1 has a history of going into the community independently. C1's Person-Centered Individual Program Plan (IPP) dated 7/10/2012 stated it was important for C1 be allowed some autonomy in the community, such as going to the movies or shopping independently.

Based on documentation and interviews, C1 is comfortable with having some independence and demonstrated they knew what to do if they got too hot waiting in the car. Past IPPs encouraged C1 have some level of independence in the community. Therefore, this allegation is deemed unsubstantiated at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2