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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 10/18/2022
Date Signed: 10/18/2022 04:51:52 PM

Document Has Been Signed on 10/18/2022 04:51 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:
10/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Belen GutierrezTIME COMPLETED:
02:20 PM
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
Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced required annual visit
to the above facility. LPA Ascencio met with the House Lead Belen Gutierrez and explained the reason
for the visit. This annual had a specific emphasis on infection control practices and procedures. Administrator Maria Drummond was not able to join LPA but authorized House Lead Gutierrez to sign documents. At 12:35 p.m., the LPA, along with House Lead toured the physical plant areas inside and outside to ensure there are no health and safety hazards. This home is vendor by Tri-Counties Regional Center.

BEDROOMS: All clients rooms are set up with beds, night stands, lamps, chests of drawers,
chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean
linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a
bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for
easy passage between the beds. In addition, no bedroom was used as a passageway to another
room, bath or toilet. There are 4 (four) total bedrooms for clients on the permanent side of the home – all of which are private rooms. The Crisis Section of the home has two (2) private bedrooms for clients.

RESTROOMS: There are four (4) total bathrooms at the home. One (1) is designated
as a staff bathroom and 1 is in the Crisis Section of the home. The clients bathrooms has a shower with non-skid materials. The toilet and showers have grab bars. The hot water temperature was tested in the bathrooms and kitchen. Areas were found to be within the range of 105*F and 120*F.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and
good condition. At the time of the visit, common seating area and dining room furniture was
observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social
distancing.
Continued on LIC 809 - C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 10/18/2022
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
The LPA observed the required postings in the common hallway. Fire extinguishers were
observed to be serviced within the last year. There are 3 fire extinguishers throughout the
house. The facility smoke alarm system is hard wired. The medication room was observed to be
locked and contained 30 days of medication. The garage was observed locked and contained the
emergency food supply. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted.

KITCHEN: Kitchen knives are stored in a locked cabinet the kitchen. The supply of dishes,
utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees
Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation
area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans
had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet
located in a locked room by the kitchen. No flies or other vermin were observed

INFECTION CONTROL: During today’s visit, the LPA spoke with the House Lead regarding the
facility’s infection control practices at 1:15 p.m. There is 1 entry into the facility. Upon entry, the
facility has a central entry point for symptom screening. The LPA noted that the facility is allowing
visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal
Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The
facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time.

The facility’s policies and procedures as it pertains to infection control are adequate.

No citations were issued during today’s visit.

Exit interview conducted. A copy of the report was provided via email to House Lead.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2