565802463-9-27-2023-29-AS-TCAA-CW3QQB-20230927122204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 09/27/2023
Date Signed: 09/27/2023 12:22:19 PM

Document Has Been Signed on 09/27/2023 12:22 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	PEOPLE'S CARE HOWE		FACILITY NUMBER:	565802463
ADMINISTRATOR:	DANSHELLE DAY		FACILITY TYPE:	735
ADDRESS:	3851 HOWE RD		TELEPHONE:	(805) 398-5096
CITY:	FILLMORE	STATE: CA	ZIP CODE:	93015
CAPACITY: 6		CENSUS: 5	DATE:	09/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Danshelle Day		TIME COMPLETED:	12:30 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) Teresa Camara conducted an unannounced required annual visit to the above facility. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett. LPA met with administrator Danshelle Day and explained the reason for the visit. At 11:10 a.m. LPA conducted a tour of 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: There are six client bedrooms; four rooms on the permanent side and two rooms on the crisis side. All rooms were clean, appropriately furnished and had sufficient lighting. RESTROOMS: There are four (4) total bathrooms at the home. One (1) is designated as a staff bathroom and is located next to the administrator's office. The medications are stored in locked cabinets inside the locked staff bathroom. One (1) bathroom is located on the crisis side of the facility. Two additional bathrooms are located on the permanent side. All bathrooms were clean and the client bathrooms had non-skid materials and grab bars. Hot water tested between 105F and 109.7F. Cleaning supplies are stored in a locked closet next to the laundry room. (continued on 809-C)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PEOPLE'S CARE HOWE	FACILITY NUMBER: 565802463
	VISIT DATE: 09/27/2023

NARRATIVE

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(continued from 809)

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. The LPA observed the required postings in the common hallway. Fire extinguishers were last serviced 9/7/2023. Smoke and carbon monoxide alarms were tested and functioned properly. The garage was locked. There was an emergency food supply inside the house. Additional food supplies were observed in the garage and laundry room. The backyard has a covered outdoor area equipped with furniture for client use. The licensee is having landscaping work done and intends to have additional seating areas outside once the work is completed. The licensee is also working on outdoor repairs to the garage walls. There were no bodies of water noted.

KITCHEN: Kitchen knives are stored in a locked cabinet in 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. No flies or other vermin were observed

No citations were issued during today’s visit. LPA must return at a later date to continue the annual visit.
Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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