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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:26:45 PM

Document Has Been Signed on 04/22/2022 03:26 PM - 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 HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:CARLOS MARCIAFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 5DATE:
04/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Carlos MarciaTIME COMPLETED:
10:45 AM
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This is the amended report that supersedes the initial report dated 04/11/2022.

Licensing Program Analyst (LPA) Angel Ascencio and Quality Assurance Specialist (QA) Liz Arced-Arnett conducted a Case Management-Incident visit regarding an incident report that was received on 04/08/22 regarding an inappropriate touching between two clients that occurred on 04/06/22. LPA and QA met with Administrator Carlos Marcia. On 04/22/22, this report was amended due to incorrect wording, which does not change the original findings of the unsubstantiated issued referenced on 04/11/22.

During the visit, LPA and QA interviewed Staff #1 (S1), S2, Client #1 (C1), and C2 starting at 11:15 AM. Interviews with staff revealed that C1 was in their room changing, sitting by the window and told staff that C2 came up to their window from the outside and touched them inappropriately. Further interviews revealed that law enforcement was called on 4/08/22 and spoke to C1 about the incident upon arrival. C1 recanted their allegations to law enforcement and law enforcement documented on a Field Interview Card on that day. S1 also proceeded to interview C1 and C2 separately. While being interviewed by S1, C1 stated that the claim of inappropriate touching was false. S1 also obtained a written statement dated 04/08/22, which stated the following " It did not happen what C2 did. Sincerely C1. I Apologize."

LPA received a copy of the statement made by C1, Service Notes regarding C1, and discharge paperwork for a hospital visit on 4/7/22, which indicated a urinary tract infection (UTI) as a diagnosis. Interview with C1 starting at 12:00 p.m., revealed that C1 was forced to tell a lie regarding the situation. C1 said that S1 was forcing them to lie to the police because they would go to jail and that is why they did not tell them the truth. C1 added that, C1 was sitting by the window, C2 came up to the window and reached in to move C1's leg and touched them inappropriately.

Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 04/22/2022
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Interview with C2 starting at 12:54 pm revealed that C2 did walk to C1's window and peaked in after C1 had called C2 over. When interviewing S1 and S2, it was revealed that S1 and S2 reviewed the video surveillance footage and revealed that C2 walked up to C1’s window for about nine (9) seconds, had their hands on the outside of the windowsill, and peaked in with their head on the outside of the window.

Based on information gathered during today's visit, there will be no citation regarding the alleged appropriate touching at this time.

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

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

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
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