<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 05/29/2024
Date Signed: 05/29/2024 09:52:07 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
05/03/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20240503151823
FACILITY NAME:PEOPLE'S CARE HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:DANSHELLE DAYFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:6CENSUS: 4DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Danshelle DayTIME COMPLETED:
09:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff allegedly choked Resident.
Reporting Requirements - choking incident not reported to Licensing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 05/10/2024 by LPA M. Arroyo. During today's visit, LPA met with Administrator, Danshelle Day. Entrance interview.

During the initial visit on 05/10/2024, LPA Arroyo conducted interviews with two (2) staff members and one (1) resident between 9:32 a.m. and 10:30 a.m., conducted a resident file review at 11:00 a.m., and obtained copies of pertinent documents relevant to the investigation. LPA Arroyo also conducted telephonic interviews with staff members on 05/10/2024 at 4:30 p.m., and on 05/15/2024 at 4:17 p.m.

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

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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-20240503151823
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: 05/29/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC 9099...

It was alleged that staff choked resident and choking incident was not reported to Licensing. It was reported that Staff #1 (S1) was observed holding Resident #1’s (R1’s) arm after R1 had become physically aggressive kicking and hitting S1 after allegedly being choked by S1. Records review of R1’s physician’s report dated 05/18/2023 notates R1’s mental health status as fair and states R1 is able to follow instructions frequently and has no problem communicating. Interviews conducted with staff revealed that R1 had become upset after being caught trying to steal cake from another resident. When S1 verbally redirected R1, R1 became aggressive and kicked S1. However, S1 stated that R1 apologized to them afterwards. After the alleged choking incident, staff stated that a body check was conducted on R1, and that redness and scratches/marks were not visible on R1’s neck and shoulders/back. Records reviewed and staff interviews conducted also revealed that a former staff present at the facility during the alleged choking incident had communicated with the Administrator via text message and communication corroborated with other interviews conducted stating that R1 had become aggressive and was swinging at S1; however, S1 blocked R1’s hits and was able to verbally deescalate the situation. Staff interviews further revealed that law enforcement had been called to do a wellness check at the facility that evening and R1 admitted to being mad because they did not get a piece of cake. Additionally, during an interview with R1, R1 denied being hit or choked by any staff member while living at the facility and did not display any signs of distress during the interview. Furthermore, incident report for alleged choking on 10/08/2023 was reported to Licensing on 10/10/2023 by the facility’s Administrator. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegations of “staff allegedly choked resident” and “choking incident not reported to Licensing”. Therefore, these allegations are being deemed Unsubstantiated at this time.

Exit interview. Report was reviewed with the Administrator and a copy was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2