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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:15:44 AM

Document Has Been Signed on 06/22/2023 11:15 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 HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:TANYA KRAMERFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 5DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Danshelle DayTIME COMPLETED:
11:30 AM
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) Teresa Camara conducted a case management - incident visit to the facility regarding incidents which occurred on 3/7/23, 3/10/23, and 4/25/23 regarding Client 1 (C1) and Client 2 (C2). LPA was joined by Tri-Counties Regional Center(TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett.

During a prior visit on 3/20/23, LPA and QAS interviewed staff starting at 9:55 a.m. and 12:29 p.m. and a client at 12:07 p.m.

During today's visit on 6/22/23, LPA and QAS met with the new facility administrator Danshelle Day at 10:25 a.m. regarding an incident which took place on 4/25/23 involving C2. Pertinent documents were obtained at 10:50 a.m. This incident involved staff 1 (S1) who was also involved, along with staff 2 (S2), in the alleged incidents 3/7/23 and 3/10/23.

The administrator provided LPA with documents regarding their internal investigation of the incident which took place on 4/25/23. There were multiple staff who witnessed the incident between C2 and S1. It was found that S1 denied food and yelled at C2. Based on the witness statements S1 was placed on administrative leave and S1's employment was terminated on 5/9/23.

The administrator was not involved with the investigation of incidents in March 2023. Based on previous interviews, the story regarding the incidents were unclear. In addition, both staff allegedly involved in the incidents in March 2023 no longer work at the facility. S1 was terminated and S2 resigned on 5/26/23.

No deficiencies were observed. Exit interview conducted and report issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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 1