565801684-9-15-2022-29-AS-DPEA-CJPTHE-20220928144437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801684
Report Date: 09/14/2022
Date Signed: 09/15/2022 08:59:15 AM

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
09/08/2022 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20220908115532

FACILITY NAME:	SVS-SIMI VALLEY		FACILITY NUMBER:	565801684
ADMINISTRATOR:	LAURA WOOD		FACILITY TYPE:	775
ADDRESS:	2381 TAPO STREET, UNIT D		TELEPHONE:	(805) 582-1752
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	60	CENSUS: 19	DATE:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Laura Wood		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Facility is operating out of ratio

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted a complaint visit to this facility today regarding above allegation. Upon arrival LPA was greeted by the front desk by staff. LPA met with Administrator Laura Woods and reason for the visit was discussed.
Between 11:30-12pm facility daily attendance records from 8/22/2022 - 9/14/2022 was reviewed with Ms. Woods and interview with staff was conducted. Daily attendance records reviewed (08/22-09/14/2022) did not show facility operating out of ratio. Staff interviewed denied allegation and stated that the program does not even operate to full capacity allowed.
Between 12-12:45pm, LPA interviewed random clients present at the facility during todays visit. Four (4) out Four (4) clients interviewed reported that the program operates with 3-4 clients in a group. Clients interviewed reported that they have not observed program to be crowded (over capacity).

Based on the interviews conducted and records reviewed allegation "Facility is operating out of ratio" is deemed unsubstantiated at this time. Exit interview conducted. Copy of report emailed to Ms. Woods.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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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