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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802410
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:10:29 AM

Document Has Been Signed on 10/10/2024 11:10 AM - 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:PEOPLE'S CARE GOODENOUGHFACILITY NUMBER:
565802410
ADMINISTRATOR/
DIRECTOR:		DANIELA MOSQUERAFACILITY TYPE:
735
ADDRESS:2591 GOODENOUGH RDTELEPHONE:
(805) 524-5617
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 6DATE:
10/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Rudi Otani - House ManagerTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management – Incident visit at 09:45 a.m. for the purpose of investigating self reported incident reports.  LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz-Aced-Arnett. Upon arrival, LPA and QAS met with House Manager Rudi Otani and explained the reason for the visit.

On 09/30/2024, at approx 07:45 a.m. Program Director received a call from BCBA from TASC Day Program regarding Client #1 (C1) statements alleging that C1 was verbally harassed by Staff. Regional Office (RO) also received information that staff sleep in common areas and smoke marijuana from a bong in the backyard while on duty.

Today, LPA and QAS conducted physical plant, interviewed staff, clients and reviewed and obtained copies of pertinent documentation relevant to the investigation. At approx 10:00 a.m (3) clients left the home.

LPA and QAS interviews with two (2) staff and C1 did not reveal sufficient evidence of the allegations listed above. Each person interviewed also did not express any immediate or potential concerns for staff becoming physically or verbally aggressive, smoking marijuana and sleeping in the common areas at this time.  Records review of internal investigation conducted by Program Manager and House manager  did not reveal any immediate or potential concerns for staff sleeping or smoking marijuana at this time.

Based on interviews and records review no immediate or potential  health and safety concerns were observed during the visit and no deficiencies cited at this time.

LPA has determine further investigation is needed and will return at a later date to complete the investigation if warranted.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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