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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801684
Report Date: 11/14/2024
Date Signed: 11/14/2024 01:42:42 PM

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
11/13/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20241113085418
FACILITY NAME:SVS-SIMI VALLEYFACILITY NUMBER:
565801684
ADMINISTRATOR:LAURA WOODFACILITY TYPE:
775
ADDRESS:2381 TAPO STREET, UNIT DTELEPHONE:
(805) 582-1752
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:60CENSUS: 44DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Laura WoodTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegation. Upon arrival, LPA met with Case Manager, Aaric Rosette and explained the reason for the visit. The Program Director, Laura Wood arrived at 11:00 a.m. Entrance interview conducted.

During today's visit, the LPA conducted a plant tour at approximately 10:00 a.m., conducted interviews with five (5) staff and two (2) participants between 9:40 a.m. and 12:15 p.m., conducted a file review at 10:15 a.m., and obtained copies of pertinent documents.

It was alleged that facility is operating out of ratio. It is the complainant’s concern that staff leaves their assigned group with other staff and clients making it overwhelming for one (1) staff member to supervise more than four (4) clients at any given time.

Report Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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-20241113085418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SVS-SIMI VALLEY
FACILITY NUMBER: 565801684
VISIT DATE: 11/14/2024
NARRATIVE
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Report Continued from LIC 9099...

Upon arrival to the day program, the LPA observed participants accompanied by staff on their way out to their designated outings. Inside the facility, LPA observed three (3) staff members and twelve (12) participants participating in activities. Record review of staff and participant roster revealed that there are two (2) staff for every seven (7) participants for outings as the facility vans can only sit a maximum of nine (9) people. Interviews conducted with staff revealed that each staff is assigned no more than four (4) participants on any given day. Staff stated that participants at times get to chose what activity to participate in, but nonetheless, participants are rotated to ensure each group stays within the ratio of one (1) staff and four (4) participants. Interviews conducted with participants confirmed that their groups only include four (4) participants for each staff. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility is operating out of ratio”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2