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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802410
Report Date: 12/16/2022
Date Signed: 12/16/2022 12:48:50 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
10/10/2022 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20221010103702
FACILITY NAME:PEOPLE'S CARE GOODENOUGHFACILITY NUMBER:
565802410
ADMINISTRATOR:TANYA KRAMERFACILITY TYPE:
735
ADDRESS:2591 GOODENOUGH RDTELEPHONE:
(805) 524-5617
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:6CENSUS: 6DATE:
12/16/2022
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Tanya KramerTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Personal Rights
Facility Staff Isolates Residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst LPA) Angel Ascencio conducted a subsequent visit to the above facility to deliver the findings. LPA Ascencio met with Administrator Tanya Kramer at 10:40 a.m. Entrance interview conducted.

On 10/10/2022,the Department received a complaint alleging facility staff isolates residents and a personal rights violation. On 10/18/2022, LPA Ascencio and Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett conducted an interview with Client #1 (C1) starting at 10:02 a.m. During C1 interview, it was revealed that one day, at nighttime, C1 walked out of their room after midnight because they were not tired. Staff #1 (S1) was telling C1 to go back to bed. C1 stated they did not want to go to bed and began to lay on the floor and yell. C1 continued, S1 was sitting in the couch and when S1 saw C1, S1 started to drag C1 across the floor and yell at C1 stating “I’m going to treat you like the animal you are.” C1 added, S1 and C1 were on the floor, S1 stood up and stepped on my breast area.

Continued on LIC 9099 - C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
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-20221010103702
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: PEOPLE'S CARE GOODENOUGH
FACILITY NUMBER: 565802410
VISIT DATE: 12/16/2022
NARRATIVE
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C1 continues, at one point during this fight with S1, S1 kicked and stepped on me. C1 added, no other staff witnessed the incident. C1 added, the next day, C1 went to the hospital for a scheduled mammogram. C1 stated that the hospital could not find anything wrong. C1 added that the marks and bruises left from the S1 were not visible anymore the following day. C1 added that they have a hard time sleeping and because C1 is loud, staff don’t want C1 to wake up all the roommates at the home. Staff is always asking C1 to go to their room at nighttime. C1 added that they can come out of their room if they can be quiet and courteous towards the roommates. C1 added there are times that I get upset hit staff, throw items, and yell at staff.

Later that same day, LPA Ascencio reviewed the medical files for C1 starting at 11:30 a.m. Review of files revealed that C1’s diagnosis is psychotic disorder, depressive disorder, mild intellectual disability, paranoid schizophrenia, psychosis, dysmenorrhea, seborrhea and general pain. C1 medical file also includes past history of physical aggression, verbal threats towards staff and peers, verbal aggression and unsafe behaviors. C1 moved to People’s Care Goodenough on 08/01/2022 and resides in the Crisis Intervention Unit. Interview with S2, on 12/16/2022, starting at 11:49 a.m. revealed that they work with S1 at night most of the week. S2 stated they get called by S1 all the time to the Crisis Intervention area because C1 has ongoing having behavior issues specifically during nighttime. S2 stated that C1 like to crawl on the floor and provoking staff members seeking attention. When C1 does not get what they want, C1 begins to yell profanity towards staff, at times tries to get physical with staff. S2 added that C1’s behavior issues happen almost every night and S1 is always professional. S2 lastly added they have not witnessed S1 get physical, or verbal with C1 when C1 is having behavior issues.

Later that same day, interview with S1 starting at 12:12 p.m. revealed that every night is a challenging behavior night with C1. S1 stated they don’t remember the exact date because C1 has behaviors of similar sorts daily. S1 stated that behaviors range from hitting, kicking, slapping, name calling when C1 does not get what they want. S1 says that C1 ask to go outside and S1 lets them. C1 asks for a cigarette or tea, and at first S1 stated they were providing it, but C1 starts to throw the items towards staff. S1 added that C1 throws themselves to the ground, start to pull their own hair, hit themselves in the arm, head and stomach area. S1 stated that throughout the behavior C1 exhibits, S1 has always stayed professional and has not engage C1 in any verbal or physical altercations.

Based on evidence gathered during the course of this investigation, the allegation of facility staff isolates residents, and Personal rights violation is deemed unsubstantiated at this time.

Exit interview conducted and a copy of the report provided to Administrator via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC9099 (FAS) - (06/04)
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