565802463-10-29-2021-29-AS-KHEN-C9929X-20211129161240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 10/28/2021
Date Signed: 10/29/2021 10:15:27 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
07/19/2021 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20210719153140

FACILITY NAME:	PEOPLE'S CARE HOWE		FACILITY NUMBER:	565802463
ADMINISTRATOR:	POURI, KIRSTEN		FACILITY TYPE:	735
ADDRESS:	3851 HOWE RD		TELEPHONE:	(805) 398-5096
CITY:	FILLMORE	STATE: CA	ZIP CODE:	93015
CAPACITY:	6	CENSUS: 5	DATE:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Carlos Marcia		TIME COMPLETED:	12:53 PM

ALLEGATION(S):

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Staff engages in inappropriate interactions with resident
Staff caused injuries to a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced subsequent complaint visit to the above facility. The purpose of the visit is to conclude an investigation initiated by LPA on 7/21/2021. Upon arrival, LPA met with Carlos Marcia, administrator at 10:55 a.m. Entrance interview conducted and the reason for the visit was explained.

On 07/19/2021, the Department received a complaint alleging that staff engage in inappropriate interactions with residents. On 07/19/2021, this complaint was referred to Community Care Licensing Division’s (CCLD) Investigations Branch (IB) and accepted as an assignment. Investigator Olivia Spindola was assigned to conduct an interview with the alleged victim.

Continued on LIC - 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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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Control Number 29-AS-20210719153140

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 HOWE	FACILITY NUMBER: 565802463
	VISIT DATE: 10/28/2021

NARRATIVE

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On 7/22/2021 at 8:00 AM, Investigator Spindola interviewed client #1 (C1) at the facility. Based on the interview, there is no evidence to support C1 has been touched inappropriately by staff.

LPA Ascencio continued the investigation and conducted staff interviews on 7/21/21, 7/29/21, 8/11/21 and 8/18/21. An additional interview with C1 on 7/21/21 revealed no additional evidence to support the allegation. Although the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time.

The complaint also alleged that staff caused injuries to resident. During the course of the investigation, interviews were conducted with multiple staff on different occasions: 7/21/21, 7/29/21, 8/11/21 and 8/18/21. LPA also conducted an interview with C2 and C3 on 7/29/21, which revealed no additional evidence to support the allegation. Photographs of C2 were obtained as evidence on 8/11/2021. Additionally, a facility file review was conducted, and facility chart notes were obtained on 7/21/21. Although the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time.

Although both allegations have been determined to be unsubstantiated, a conversation was held with the Administrator during the exit interview of today’s visit. LPA stressed the importance of knowing clients’ personal rights and having staff that are property trained. Administrator stated they will conduct additional training.

Exit interview conducted. Copy of the report provided via email to admin.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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