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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 08/25/2023
Date Signed: 08/25/2023 12:15:25 PM

Document Has Been Signed on 08/25/2023 12:15 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:TANYA KRAMERFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 5DATE:
08/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Danshelle DayTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted a Case Management - Incident visit regarding a self-reported incident which took place on 8/21/2023. LPA met with administrator Danshelle Day and explained the reason for the visit.

LPA conducted an interview with the administrator at 10:17 a.m. LPA conducted a brief facility tour and inspected the room of Client 1 (C1) at 11:58 a.m. LPA reviewed the staff schedule at 11:28 a.m. The staffing at the facility on the date of the incident was sufficient. All clients were at the facility that day. There was one staff on the crisis side for one client. There were two staff plus the administrator on the permanent side. One of the staff on the permanent side was assigned as a one-to-one (1:1) for Client 2 (C2). There were two more clients who were monitored by Staff 1 (S1) and the administrator.

On 8/21/2023 at approximately 12:45 p.m. C1 had a behavioral incident in the facility. C1 was trying to enter the crisis side of the facility. S1 redirected C1 but C1 was very upset and went to their room. S1 did not follow C1 in an effort to give C1 some time to calm down. Approximately ten minutes later S1 and the administrator went to speak with C1, however C1 had locked their door. S1 unlocked the door and that is when they discovered C1 had removed the screen from their window, climbed out of the facility and used their night stand as a step ladder to climb over the perimeter fencing. (Note: there is a chime alarm on the bedroom windows but C1 likes to keep their window open so the chime alarm was not engaged.) The administrator immediately called 9-1-1 while at the same time going down the street to see if she could see C1. She asked the nearby construction workers if they saw C1; they did. They told the administrator C1 was on a scooter headed toward the mountains. The police found C1 in a ditch approximately a mile from the facility. C1 had purposely cut themself with a piece of broken glass. C1 was taken to a hospital and is now in an acute psychiatric facility. Based on the information obtained, no deficiencies were observed. Exit interview conducted and report issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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